Not Sure What to Do

I (60 yo F never smoked) had a respiratory infection in April 2024 that wouldn't go away. In June 2024 I had a chest X ray that showed "emphysemas changes and hyperinflation".

In July 2024 I had pulmonary function test which showed normal spirometry, no significant response to bronchodilator, and some mild air trapping and a diagnosis of mild COPD. The prescribed Wixela inhaler caused thrush of my mouth and esophagus, so I stopped using it.

A CT scan in September 2024 showed "patchy ground glass opacities, tree-in-bud nodularity, and bronchiectasis in bilateral upper lobes, the right middle lobe and the right lower lobe, a mucous plug in the right upper lobe, and atelectasis in right middle lobe, pointing to an infectious or inflammatory process. I was prescribed doxycycline, which seemed to help at first, then didn't. I couldn't produce sputum for culture, even with sputum induction. Blood tests for lung infections were negative.

A repeat CT in November showed little change.

A bronchoscopy was performed in late November. There were visible secretions that were "not bad, but not normal". BAL fluid from right upper lobe was cultured, but didn't grow anything except a Penicillium species thought to be a contaminant. Cell count showed Nucleated Cell count: 882, Neutrophils/100 WBC: 87, Lymphocytes/100 WBC: 7, Macrophages/100 WBC: 6

In spite of the negative cultures, Azithromycin was prescribed and wait 3 months to readdress. I'm able to go to work, but still have the same fatigue, mild shortness of breath and chest discomfort. I use my Abuterol inhaler for chest tightness usually in the morning and in the evening before bed. I don't cough up sputum.

Any ideas as to what may be going on?