Asthma differential diagnosis: Difference between revisions

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Revision as of 20:20, 26 February 2016

Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]

Overview

Asthma must be clinically differentiated from other pulmonary conditions with similar symptoms such as chronic obstructive pulmonary disease and pulmonary aspiration.

Differentiating Asthma from other Diseases

Although, many cases of recurrent cough and wheezing in children and adults are due to asthma, other conditions are often misdiagnosed as asthma.

Adults

Chronic obstructive pulmonary disease (COPD)
Hyperventilation syndrome and panic attacks
Congestive heart failure
Pulmonary embolism
Laryngeal dysfunction
Pulmonary aspiration
Mechanical obstruction of the airways (benign and malignant tumors)
Pulmonary infiltration with eosinophilia
Diffuse parenchymal lung diseases
Cough secondary to drugs (ACE inhibitors)
Vocal cord dysfunction

Infants & Children

Upper airway diseases

Allergic rhinitis and sinusitis

Obstructions involving large airways

Foreign body in trachea or bronchus Vocal cord dysfunction Vascular rings or laryngeal webs Laryngotracheomalacia, tracheal stenosis, or bronchostenosis Enlarged lymph nodes or tumor

Obstructions involving small airways

Viral bronchiolitis or obliterative bronchiolitis Cystic fibrosis Bronchopulmonary dysplasia

Other causes

Congenital heart diseases Recurrent cough not due to asthma Aspiration from swallowing mechanism Dysfunction or gastroesophageal reflux

References

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@@ Line 7: / Line 7: @@
 ==Differentiating Asthma from other Diseases==
-* Before diagnosing someone with asthma, [[differential diagnosis|alternative possibilities]] should be considered.
+* Although, many cases of recurrent cough and wheezing in children and adults are due to asthma, other conditions are often misdiagnosed as asthma.
-* A clinician taking a history should check whether the patient is using any known bronchoconstrictors; these substances cause narrowing of the airways, e.g., certain [[anti-inflammatory]] agents or [[beta-blockers]] and can mimic asthmatic symptoms.
+===Adults===
-* [[Chronic obstructive pulmonary disease]], which closely resembles asthmatic symptoms, is correlated with:
+*Chronic obstructive pulmonary disease (COPD)
-:* More exposure to cigarette smoke
+*Hyperventilation syndrome and panic attacks
-:* An older patient
+*Congestive heart failure
-:* Less symptom reversibility after bronchodilator administration (as measured by [[spirometry]])
+*Pulmonary embolism
-:* Decreased likelihood of family history of [[atopy]]
+*Laryngeal dysfunction
-* [[Pulmonary aspiration]], whether direct due to [[dysphagia]] (swallowing disorder) or indirect (due to acid reflux), can show similar symptoms to asthma. However, with aspiration, fevers might also indicate [[aspiration pneumonia]]. Direct aspiration (dysphagia) can be diagnosed by performing a Modified Barium Swallow test and treated with feeding therapy by a qualified speech therapist. If the aspiration is indirect (from acid reflux) then treatment directed at this is indicated.
+*Pulmonary aspiration
+*Mechanical obstruction of the airways (benign and malignant tumors)
+*Pulmonary infiltration with eosinophilia
+*Diffuse parenchymal lung diseases
+*Cough secondary to drugs (ACE inhibitors)
+*Vocal cord dysfunction
+===Infants & Children===
+=====Upper airway diseases=====
+Allergic rhinitis and sinusitis
+=====Obstructions involving large airways=====
+Foreign body in trachea or bronchus
+Vocal cord dysfunction
+Vascular rings or laryngeal webs
+Laryngotracheomalacia, tracheal stenosis, or bronchostenosis
+Enlarged lymph nodes or tumor
+=====Obstructions involving small airways=====
+Viral bronchiolitis or obliterative bronchiolitis
+Cystic fibrosis
+Bronchopulmonary dysplasia
+=====Other causes=====
+Congenital heart diseases
+Recurrent cough not due to asthma
+Aspiration from swallowing mechanism
+Dysfunction or gastroesophageal reflux
 ==References==