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Have moist rumbling cough. Taking Clindamycin. Having ear ache. Noticing breathing exhale from lungs smells like pseudomonas. What to do?

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Practicing since : 2009
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have had a very deep moist rumbling cough since Mother's day. At first of year had same but the MD ordered Clindamycin and it did nothing for it. So it went on and on. Now is unbearable. Ear ache also started--MD said ears clear. Went to MD one week ago CXR said to be okay. Have been taking the Singular tid, and the Tessalon Pearls tid as ordered to no avail. Now I'm noticing that the breathing exhale from lungs smells like pseudomonas. Ex-husband was Resp. Therapist. Fatigue, low grade temps, flushing. I have Rheumatoid Arthritis and have been treated for 2yrs with Humira, then another 11/2 yr with Enbrel two years ago. The MD that I saw a week ago said something about Rheum. Lung and if things didn't get a bit better maybe an MRI of chest/lungs need. Last nite I had trouble with feeling like I couldn't get a full breath on inhaling. Of course I failed the pulmonary test in MD office. Can't talk without hacking almost to point of throwing up. Most antibiotics don't work for me at all. Needed Vancomycin thru my port in chest for three months after each total knee replacement (last one Nov. 2012) for severe cellulitis in area below knee all way to toes. Last dose of Vancomycin was March 2013 for recurrence of same. What is next? Thank You--XXXXX
Posted Tue, 5 Nov 2013 in Medicines and Side Effects
Answered by Dr. Rakesh Madhyastha 2 hours later
Brief Answer:
Bronchoscopy required

Detailed Answer:

Thanks for the query

It is true that your chest condition does not look like a Rheumatoid lung, in rheumatoid lung you would mostly get dry cough and not a moist one.
It also looks like you have been treated for repeated chest infections with antibiotics. If I were your doctor I would have ordered a Bronchoscopy next and would have sent a broncho alveolar lavage for routine, culture and sensitivity. High resolution CT chest is also required at this stage for you.
I would like to add here that since you are having wet cough, a cough suppressant (Tessalon Pearls) might not be a good idea as it will retain the secretions which might lead to an infection, you might want to switch over to a cough expectorant instead. Continue taking Singular.

In the mean time please follow these suggestions
1. Avoid cold food items and beverages
2. Avoid exposure to cold environment
3. Chest physiotherapy and incentive spirometry will help

I hope I was of help, if you have any further queries please get back to me

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