Differential diagnosis of common respiratory conditions

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Diagnosis  Suggestive features 

COPD

(Chronic Obstructive Pulmonary Disorder)

Onset in mid-life

Symptoms slowly progressive
History of tobacco smoking or exposure to other types of smoke
Physical activity
Flu vaccination
Pneumococcal vaccination

Asthma Onset early in life (often childhood)

Symptoms vary widely from day to day
Symptoms worse at night/early morning
Allergy, rhinitis, and/or eczema also present
Family history of asthma
Obesity coexistence

Congestive heart failure Chest X-ray shows dilated heart, pulmonary oedema.

Pulmonary function tests indicate volume restriction, not airflow/imitation

Bronchiectasis Large volumes of purulent sputum

Commonly associated with bacterial infection
Chest X-ray/CT shows bronchial dilation, bronchial wall thickening.

Tuberculosis Onset all ages

Chest X-ray shows lung infiltrate
Microbiological confirmation
High local prevalence of tuberculosis

Obiterative bronchiolitis Onset at younger age, non-smokers

May have history of rheumatoid arthritis or acute fume exposure
Seen after lung or bone marrow transplantation
CT on expiration shows hypodense areas

Diffuse panbronchiolitis Predominantly seen in patients of Asian descent

Most patients are male and non-smokers
Almost all chronic sinusitis
Chest/X-ray and high-resolution computed tomography show diffuse small centrilobular nodular opacities and hyperinflation

These features tend to be characteristic of the respective diseases, but are not mandatory. For example, a person who has never smoked may develop COPD (especially in the developing world where other risk factors may be more important than cigarette smoking); asthma may develop in adult and even in elderly patients.

 

Editorial Information

Last reviewed: 06 March 2019

Next review: 31 March 2021

Author(s): Advanced Practice Respiratory Nurse

Version: 1

Approved By: Awaiting ratification by TAM Subgroup

Reviewer Name(s): Michelle Duffy