Cystic fibrosis differential diagnosis: Difference between revisions

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Revision as of 19:06, 7 March 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shaghayegh Habibi, M.D.[2]

Overview

Cystic fibrosis has to be differentiated from other conditions with similar presentation of cough and wheeze like asthma, bronchiolitis, COPD, bacterial pneumonia, emphysema, primary ciliary dyskinesia (Kartagener syndrome) and Alpha 1-antitrypsin deficiency.

Differentiating cystic fibrosis from other Diseases

Differential diagnosis of cough with wheezes is :

Diseases	Symptoms			Signs			Diagosis
Diseases	Fever	Cough	Chest pain	Wheezes	Crackles	Tachypnea	Lab tests	Imaging
Asthma	-	Dry/Productive	-	+	-	+	Lab tests to exclude other diseases. Serum examination shows elevated level of eosinophils due to allergy.	CT scan shows: Dilated bronchi. Bronchial wall thickening. Air trapping.
Bronchiolitis	+/-	Dry	-	+	+	+/-	ELISA and immunoassays may be done in case of RSV infection. Pulmonary function test to exclude other lung diseases.^[1]	CT scan shows: Intense bronchiolar mural inflammation. bronchial wall thickening. Centrilobular nodules with tree-in-bud pattern.
COPD	+	Productive	-	+	+	+	Spirometry: FEV1/FVC < 70%. Arterial blood gases: hypoxemia and hypercapnia. Sputum culture.	EKG may show: P pulmonale. right ventricular hypertrophy. Narrow QRS.^[2] CT scan is more sensitive in diagnosing COPD than X ray.
Bacterial pneumonia	+	Productive	+	+	+	+/-	Diagnosis depends on presentation and physical examination. Laboratory tests: arterial blood gases may show hypoxia and acidosis. Sputum culture.	X ray is performed to detect: pleural effusion. Inflitrates within the lungs. CT scan shows: Consolidation. Ground glass appearance.
Cystic Fibrosis	+/-	Productive	+/-	-	-	+	Cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction evidenced by : Elevated sweat chloride ≥60 mmol/L (on two occasions). Presence of two disease-causing mutations in CFTR, one from each parental allele. Abnormal nasal potential difference.	X-ray : Hyperinflation presents as: Flattening of the diaphragm. Anterior bowing of the infant sternum. Increased retrosternal air space. Generalized pulmonary overinflation. Multiple nodular densities represent mucus plugging and may present in finger-in-glove shape or as a combination of V- or Y-shaped branching and bandlike shadows. Abdominal findings include dilated multiple loops of the small bowel are seen in neonatal meconium ileus.
Emphysema	+/-	Productive	-	+	+/-	+	Arterial blood gas analysis: mild-to-moderate hypoxemia without hypercapnia that progresses to worsening hypoxemia and hypercapnia develops. Chronic hypoxemia may lead to polycythemia. Sputum is mucoid and the predominant cells are macrophages.	Chest X-ray reveals signs of emphysema include: Flattening of diaphragm. Increased retrosternal air space (see on lateral chest films). A long narrow heart shadow. Tapering vascular shadows. Hyperlucency of the lungs.
Primary Ciliary Dyskinesia (Kartagener Syndrome)	+/-	Productive	-	+	+	+	Low or absent amount of nasal nitric oxide (nNO). Mucociliary clearance may be useful for screening. Confirmation with tests of ciliary function.	Chest X-ray reveals : Bronchial wall thickening. Bronchiectasis and hyperinflation. Cystic bronchiectasis with air-fluid levels may be visible. Usually involves the lower and middle lobes.
Alpha 1-antitrypsin deficiency	+/-	Productive	-	+	+	+	Reduced concentration of serum alpha1-antitrypsin levels is diagnostic of AATD. Moderate-to-severe airflow obstruction with an FEV1. Reduced vital capacity. Increased lung volumes secondary to air trapping (residual volume >120% of predicted value) are usually present.	Chest X-ray Alpha1-antitrypsin deficiency (AATD) emphysema presents as: a hyperlucent appearance because healthy tissue has been destroyed. Affected regions also are described as oligemic because they lack the normal rich pattern of branching blood vessels. An unusual characteristic in alpha1-antitrypsin deficiency is found in about 60% of PiZZ patients is a striking basilar distribution. In contrast, cigarette smoking is associated with more severe apical disease.

Cough

Organ system		Diseases	Clinical manifestations								Diagnosis				Other features
			Symptoms							Physical exam	Diagnosis
			Onset	Duration	Productive cough	Hemoptysis	Weight lost	Fever	Dyspnea	Ascultation	Lab findings	Imaging	PFT	Gold standard
Respiratory	Upper airway diseases	Common Cold^[3]	Acute	3-10 days	✔	-	-	✔	-	Rales Wheezing	Bacterial culture is not indicated	Chest X-Ray in patients with signs of consolidation	Normal function	Clinical diagnosis	Conjunctival injection Nasal congestion
	Lower airway	Asthma^[4]	Chronic	Years	✔ Clear mucoid or yellow sputum	-	-	-	✔	Wheezing (expiratory) Rales Rhonchi	Eosinophilia is observed in complete blood count (CBC) Total serum IgE in test for allergy	Normal airways in chest X-ray CT if there any abnormality in chest X-Ray	FEV1/FVC ratio <70% and FEV1 >15% increase after 15 minutes of 2 puffs of beta 2 sympathomimetic drug After physical active FEV1 decreases by >15% After inhaled corticosteroid (ICS)FEV1 increased by >15%	Airflow limitation on spirometry	Family history Seasonal variation
		Acute Bronchitis^[5]	Acute	From 5 days to 1 or 3 weeks	✔	-	-	-	✔	Wheezing Rhonchi	Sputum culture is not indicated PCR in bacterial infection	Chest X-ray to exclude other diseases	FEV1 < 80%	Clinical diagnosis	Majority of cases are caused by respiratory viruses
		Chronic Bronchitis^[6]^[7]	Chronic	Most of the days for three months in the las two years.	✔ Clear sputum	-	-	✔	✔	Wheezing Rhonchi	Blood test Arterial blood gas (ABG)	Chest X-Ray to exclude other diseases CT	FEV1/FVC ratio < 70% Post bronchodilatador FEV1 > 80% Reduced FVC after bronchodilatador administration Decread vital capacity Increased total lung capacity	Demostration of airflow limitation on spirometry	Smoker's cough Cigarette smoking Pollution
		Non-asthmatic eosinophilic bronchitis^[8]^[9]	Chronic	More than 8 weeks	✔ Eosinophilic sputum		-	-	✔	Wheezing Shortness of breath	High levels of IgE Airway eosinophilia in sputum induction or bronchial wash fluid from bronchoscopy (bronchoalveolar lavage)	Normal chest X-Ray	FEV1/FVC >70% No response of short acting bronchodilator	Bronchial biopsy eosinophilia	Exposure to an occupational cause
		Bronchiectasis^[10]	Chronic	Months to years	✔ Mucopurulent sputum	✔		-	✔	Crackles Wheezing Shortness of breath	Complete blood count (CBC) IgG, IgM and IgA Sputum culture for fungi, bacteria and mycobacteria	Linear atelectasis and dilated airways in chest X-Ray	FEV1/FVC <70% Normal FVC Low levels of FEV1	CT of chest	Digital clubbing Recurrent pleurisy
		Emphysema ^[11]	Chronic	Months to years	✔ Mucoid or purulent sputum	-	-	✔	✔	Shortness of breath Wheezing Prolonged expiration Crackles	Blood test Testing for alpha 1-antitrypsin	Chest X-Ray to exclude other diseases CT	FEV1/FVC <70% Post bronchodilator FEV1 >80	Detection of early emphysema in CT of chest	Exposure of tobacco and air pollution
		Foreing body aspiration^[12]^[13]^[14]	Acute	Variable	✔	✔	-	✔	✔	Wheezing Decreased breath sounds	No specific	Hyperinflated lungs, atelectasis, and mediastinitis Shift in chest radiograph when the object is radio-opaque CT	Not specific	Bronchoscopy	In children <1 year and adults >75 years Organic materials in children Inorganic materials in adults
		Bronchiolitis^[15]^[16]	Acute	8-15 days	✔	-		✔	✔	Wheezing Crackles Increased respiratory rate	Complete blood count (CBC) Urinalysis (in infants) Urine culture ( in infants)	Chest X-Ray	Normal function or obstructive changes (FEV1/FVC <70%) Air trapping in Lung volumes Reduced Diffusing capacity of carbon monoxide ( DLCO)	Clinical diagnosis	Etiology: Respiratory syncytial virus, Rhinovirus Children <2 years
	Parenchyma	Pneumoconioses^[17]^[18]	Acute, Chronic	Years	-	-	✔	✔	✔	Wheezing Rhonchi Crackles	Arterial blood gas Complete blood count (CBC)	Small oppacities and fibrosis observed in chest X-ray CT FDG-PET	FEV1/FVC <70% FEV1 <80%	Exposure history and chest radiograph	Fibrogenic: Silica, asbestos Inert: Iron, barium Granulomatous: Beryllium Giant cell pneumonia: Cobalt
		Interstitial lung disease^[19]^[20]	Chronic	Variable	-	✔	✔	-	✔	Wheezing Crackles or velcro rales Inspiratory high-pitched rhonchi	Test for hepatic and renal function Hematologic test in differential CBC Serological testing	Nodular, reticular or both pattern in chest X-ray CT in patients with diffuse pulmonary lung disease	Reduction in FVC, RV, FRC, TLC and FEV1 on spirometry FEV1/FVC normal or increase Lung volumes Diffusion capacity (DLCO reduced)	Lung biopsy when lab, imaging, and PFT has indeterminate result	Clubbing is common in asbestosis and idiopathic pulmonary fibrosis
		Cystic fibrosis (CF)^[21]^[22]	Chronic	Variable	✔	-	✔		✔	Barrel-shaped chest Wheezing Tachypnea	Respiratory tract culture for CF Bronchoalveolar lavage for cytology ≥ 60 mmol/L Sweat chloride test CFTR mutation in molecular testing	Hyperinflation, atelectasis, and infiltrates on chest X-Ray Severe patients present bronchietasis, "tram tracks" peribronchial cuffing in chest X-Ray The extension of bronchietasis can be defined by CT	RV/TLC ratio increased FEV1/FVC ratio <70% Low levels of FEV1 High levels of TLC RV increased	Sweat chloride test	Evidence of CFTR dysfunction
Cardiac		Cardiogenic pulmonary edema^[23]^[24]	Acute	Days to weeks	✔ Pink frothy, liquid	-	✔	-	✔	Crackles Increased respiratory rate Wheezing Rhonchi Gurgling sounds	Arterial blood gas BUN Serum creatinin Serum troponin Electrolytes Lactic acid Complete blood count	Cardiomegaly, pleural effusion, interstitial edema, alveolar edema and blood redistribution in lower lobes in chest X-ray	Not specific	Clinical diagnosis Tests are supportive	12-lead ECG Plasma BNP and NT-proBNP Echocardiography
Gastrointestinal		Gastroesophageal reflux^[25]^[26]	Chronic	Variable	✔	-	✔	-	✔	Wheezing Hoarseness	Not specific	Upper endoscopy Barium esophagram	Normal function	PH testing	--
Autoinmune		Wegener's disease (GPA) ^[27]^[28]	Chronic	Months	✔	✔	✔	✔	✔	Hoarseness Stridor Wheezing	ANCA, P-ANCA, C-ANCA BUN Creatinine Complete blood count Urinalysis Lung biopsy	Nodules, pulmonary infiltrates, reticular margins, pleural opacities and cavities in chest X-Ray Nodules, cavities and stellate-shaped peripherial pulmonary in chest CT Bronchoscopy	Low levels of DLCO Reduce lung volumes	Tissue biopsy	Nasal crusting, sinus pain, chronic rhinosinusitis, nasal obstruction and discharge in upper airway Saddle nose deformity Purpura in lower extremities
		Sarcoidosis^[29]^[30]	Chronic	Years	-	-	✔	✔	✔	Wheezing Squeaky sounds	Complete blood count (CBC) Urinalysis BUN Liver function test Calcium Alkaline phosphatase levels Electrolytes Histopathologic detection	On chest X-Ray: Stage 1: Bilateral hiliar adenopathy Stage 2: Reticular opacities and hiliar adenopathy Stage 3: Shrink hiliar nodules and reticular opacities Stage 4: Lost of volume	Reduced FVC Decreased of TLC	Clinical diagnosis, histopathologic detection of noncaseating granulomas and exclusion of other diseases	Young adults Skin, joint and eye lesions
		Microscopic polyangitis (MPA)^[31]	Chronic	Variable	✔	✔	✔	✔	✔	Hoarseness Stridor Wheezing	ANCA positive BUN Creatinine Complete blood count Urinalysis	Cavitation, nodules, and alveolar opacities in chest X-ray Head and chest CT Electromyography/nerve conduction study	Reduced lung volumes	Tissue biopsy	Nerve damage Rhinosinusitis Purpura involving lower extremities
		Churg-Strauss^[32]^[33]	Chronic	Variable	✔	✔	✔	✔	✔	Wheezing Rales Rhonchi Expiratory sounds(related to asthma)	Peripherial eosinophilia In active phase CRP and erytrocyte sedimentation rate high High levels of IgE ANCA positive	Infiltrates in chest X-Ray Ground glass opacities, tree-in-bud sign and small nodules in chest CT	Lung volumes decreased FVC reduced FEV1/FVC ratio <70%	Tissue biopsy	Asthma Eosinophilia Rhinosinusitis
Medication		ACE inhibitors^[34]^[35]	Acute (depend on the medication)	From 2 weeks to 6 months	-	-	-	-	✔	Wheezing	Not required	No required	Normal function	Clinical diagnosis	Resolves in four to five days of stopping the medication Angioedema

References

↑ Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM; et al. (2008). "An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients". Respir Med. 102 (6): 825–30. doi:10.1016/j.rmed.2008.01.016. PMID 18339530.
↑ Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M (2013). "Analysis of electrocardiogram in chronic obstructive pulmonary disease patients". Med Pregl. 66 (3–4): 126–9. PMID 23653989.
↑ Eccles R (2005). "Understanding the symptoms of the common cold and influenza". Lancet Infect Dis. 5 (11): 718–25. doi:10.1016/S1473-3099(05)70270-X. PMID 16253889.
↑ Ukena D, Fishman L, Niebling WB (2008). "Bronchial asthma: diagnosis and long-term treatment in adults". Dtsch Arztebl Int. 105 (21): 385–94. doi:10.3238/arztebl.2008.0385. PMC 2696883. PMID 19626179.
↑ Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. doi:10.1056/NEJMcp061493. PMID 17108344.
↑ Brusasco V, Martinez F (2014). "Chronic obstructive pulmonary disease". Compr Physiol. 4 (1): 1–31. doi:10.1002/cphy.c110037. PMID 24692133.
↑ Qaseem A, Snow V, Shekelle P, Sherif K, Wilt TJ, Weinberger S, Owens DK (2007). "Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians". Ann. Intern. Med. 147 (9): 633–8. PMID 17975186.
↑ Brightling CE (2006). "Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 116S–121S. doi:10.1378/chest.129.1_suppl.116S. PMID 16428700.
↑ Cho J, Choi SM, Lee J, Park YS, Lee SM, Yoo CG; et al. (2018). "Clinical Outcome of Eosinophilic Airway Inflammation in Chronic Airway Diseases Including Nonasthmatic Eosinophilic Bronchitis". Sci Rep. 8 (1): 146. doi:10.1038/s41598-017-18265-2. PMC 5760521. PMID 29317659.
↑ King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW (2006). "Characterisation of the onset and presenting clinical features of adult bronchiectasis". Respir Med. 100 (12): 2183–9. doi:10.1016/j.rmed.2006.03.012. PMID 16650970.
↑ Rossi A, Butorac-Petanjek B, Chilosi M, Cosío BG, Flezar M, Koulouris N; et al. (2017). "Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies". Int J Chron Obstruct Pulmon Dis. 12: 2593–2610. doi:10.2147/COPD.S132236. PMC 5587130. PMID 28919728.
↑ Hewlett JC, Rickman OB, Lentz RJ, Prakash UB, Maldonado F (2017). "Foreign body aspiration in adult airways: therapeutic approach". J Thorac Dis. 9 (9): 3398–3409. doi:10.21037/jtd.2017.06.137. PMC 5708401. PMID 29221325.
↑ Rafanan AL, Mehta AC (2001). "Adult airway foreign body removal. What's new?". Clin. Chest Med. 22 (2): 319–30. PMID 11444115.
↑ Haddadi S, Marzban S, Nemati S, Ranjbar Kiakelayeh S, Parvizi A, Heidarzadeh A (2015). "Tracheobronchial Foreign-Bodies in Children; A 7 Year Retrospective Study". Iran J Otorhinolaryngol. 27 (82): 377–85. PMC 4639691. PMID 26568942.
↑ Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L, Lohr KN (2004). "Diagnosis and testing in bronchiolitis: a systematic review". Arch Pediatr Adolesc Med. 158 (2): 119–26. doi:10.1001/archpedi.158.2.119. PMID 14757603.
↑ "www.nice.org.uk".
↑ Jp NA, Imanaka M, Suganuma N (2017). "Japanese workplace health management in pneumoconiosis prevention". J Occup Health. 59 (2): 91–103. doi:10.1539/joh.16-0031-RA. PMC 5478517. PMID 27980247.
↑ Weiland DA, Lynch DA, Jensen SP, Newell JD, Miller DE, Crausman RS, Kuhn C, Kern DG (2003). "Thin-section CT findings in flock worker's lung, a work-related interstitial lung disease". Radiology. 227 (1): 222–31. doi:10.1148/radiol.2271011063. PMID 12668748.
↑ Lama VN, Martinez FJ (2004). "Resting and exercise physiology in interstitial lung diseases". Clin. Chest Med. 25 (3): 435–53, v. doi:10.1016/j.ccm.2004.05.005. PMID 15331185.
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↑ Farrell PM, Rosenstein BJ, White TB, Accurso FJ, Castellani C, Cutting GR, Durie PR, Legrys VA, Massie J, Parad RB, Rock MJ, Campbell PW (2008). "Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report". J. Pediatr. 153 (2): S4–S14. doi:10.1016/j.jpeds.2008.05.005. PMC 2810958. PMID 18639722.
↑ Kerem E, Reisman J, Corey M, Canny GJ, Levison H (1992). "Prediction of mortality in patients with cystic fibrosis". N. Engl. J. Med. 326 (18): 1187–91. doi:10.1056/NEJM199204303261804. PMID 1285737.
↑ Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, Massie BM, Roland E, Targum S, Collins SP, Filippatos G, Tavazzi L (2005). "Acute heart failure syndromes: current state and framework for future research". Circulation. 112 (25): 3958–68. doi:10.1161/CIRCULATIONAHA.105.590091. PMID 16365214.
↑ Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013). "2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines". Circulation. 128 (16): e240–327. doi:10.1161/CIR.0b013e31829e8776. PMID 23741058.
↑ Kahrilas PJ, Hughes N, Howden CW (2011). "Response of unexplained chest pain to proton pump inhibitor treatment in patients with and without objective evidence of gastro-oesophageal reflux disease". Gut. 60 (11): 1473–8. doi:10.1136/gut.2011.241307. PMID 21508423.
↑ Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
↑ Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS (1992). "Wegener granulomatosis: an analysis of 158 patients". Ann. Intern. Med. 116 (6): 488–98. PMID 1739240.
↑ Falk RJ, Gross WL, Guillevin L, Hoffman GS, Jayne DR, Jennette JC, Kallenberg CG, Luqmani R, Mahr AD, Matteson EL, Merkel PA, Specks U, Watts RA (2011). "Granulomatosis with polyangiitis (Wegener's): an alternative name for Wegener's granulomatosis". Arthritis Rheum. 63 (4): 863–4. doi:10.1002/art.30286. PMID 21374588.
↑ Carmona EM, Kalra S, Ryu JH (2016). "Pulmonary Sarcoidosis: Diagnosis and Treatment". Mayo Clin. Proc. 91 (7): 946–54. doi:10.1016/j.mayocp.2016.03.004. PMID 27378039.
↑ Yanardağ H, Pamuk GE, Karayel T, Demirci S (2002). "Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples". Haematologia (Budap). 32 (4): 419–25. PMID 12803116.
↑ Jennette, J. Charles; Falk, Ronald J. (1997). "Small-Vessel Vasculitis". New England Journal of Medicine. 337 (21): 1512–1523. doi:10.1056/NEJM199711203372106. ISSN 0028-4793.
↑ Vaglio A, Buzio C, Zwerina J (2013). "Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): state of the art". Allergy. 68 (3): 261–73. doi:10.1111/all.12088. PMID 23330816.
↑ Lanham JG, Elkon KB, Pusey CD, Hughes GR (1984). "Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome". Medicine (Baltimore). 63 (2): 65–81. PMID 6366453.
↑ Israili ZH, Hall WD (1992). "Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology". Ann. Intern. Med. 117 (3): 234–42. PMID 1616218.
↑ Wood R (1995). "Bronchospasm and cough as adverse reactions to the ACE inhibitors captopril, enalapril and lisinopril. A controlled retrospective cohort study". Br J Clin Pharmacol. 39 (3): 265–70. PMC 1365002. PMID 7619667.

Template:WH Template:WS

[pmid18339530-1] Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM; et al. (2008). "An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients". Respir Med. 102 (6): 825–30. doi:10.1016/j.rmed.2008.01.016. PMID 18339530.

[pmid23653989-2] Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M (2013). "Analysis of electrocardiogram in chronic obstructive pulmonary disease patients". Med Pregl. 66 (3–4): 126–9. PMID 23653989.

[pmid16253889-3] Eccles R (2005). "Understanding the symptoms of the common cold and influenza". Lancet Infect Dis. 5 (11): 718–25. doi:10.1016/S1473-3099(05)70270-X. PMID 16253889.

[pmid19626179-4] Ukena D, Fishman L, Niebling WB (2008). "Bronchial asthma: diagnosis and long-term treatment in adults". Dtsch Arztebl Int. 105 (21): 385–94. doi:10.3238/arztebl.2008.0385. PMC 2696883. PMID 19626179.

[pmid17108344-5] Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. doi:10.1056/NEJMcp061493. PMID 17108344.

[pmid24692133-6] Brusasco V, Martinez F (2014). "Chronic obstructive pulmonary disease". Compr Physiol. 4 (1): 1–31. doi:10.1002/cphy.c110037. PMID 24692133.

[pmid17975186-7] Qaseem A, Snow V, Shekelle P, Sherif K, Wilt TJ, Weinberger S, Owens DK (2007). "Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians". Ann. Intern. Med. 147 (9): 633–8. PMID 17975186.

[pmid16428700-8] Brightling CE (2006). "Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 116S–121S. doi:10.1378/chest.129.1_suppl.116S. PMID 16428700.

[pmid29317659-9] Cho J, Choi SM, Lee J, Park YS, Lee SM, Yoo CG; et al. (2018). "Clinical Outcome of Eosinophilic Airway Inflammation in Chronic Airway Diseases Including Nonasthmatic Eosinophilic Bronchitis". Sci Rep. 8 (1): 146. doi:10.1038/s41598-017-18265-2. PMC 5760521. PMID 29317659.

[pmid166509702-10] King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW (2006). "Characterisation of the onset and presenting clinical features of adult bronchiectasis". Respir Med. 100 (12): 2183–9. doi:10.1016/j.rmed.2006.03.012. PMID 16650970.

[pmid28919728-11] Rossi A, Butorac-Petanjek B, Chilosi M, Cosío BG, Flezar M, Koulouris N; et al. (2017). "Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies". Int J Chron Obstruct Pulmon Dis. 12: 2593–2610. doi:10.2147/COPD.S132236. PMC 5587130. PMID 28919728.

[pmid29221325-12] Hewlett JC, Rickman OB, Lentz RJ, Prakash UB, Maldonado F (2017). "Foreign body aspiration in adult airways: therapeutic approach". J Thorac Dis. 9 (9): 3398–3409. doi:10.21037/jtd.2017.06.137. PMC 5708401. PMID 29221325.

[pmid11444115-13] Rafanan AL, Mehta AC (2001). "Adult airway foreign body removal. What's new?". Clin. Chest Med. 22 (2): 319–30. PMID 11444115.

[pmid26568942-14] Haddadi S, Marzban S, Nemati S, Ranjbar Kiakelayeh S, Parvizi A, Heidarzadeh A (2015). "Tracheobronchial Foreign-Bodies in Children; A 7 Year Retrospective Study". Iran J Otorhinolaryngol. 27 (82): 377–85. PMC 4639691. PMID 26568942.

[pmid14757603-15] Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L, Lohr KN (2004). "Diagnosis and testing in bronchiolitis: a systematic review". Arch Pediatr Adolesc Med. 158 (2): 119–26. doi:10.1001/archpedi.158.2.119. PMID 14757603.

[urlwww.nice.org.uk-16] "www.nice.org.uk".

[pmid27980247-17] Jp NA, Imanaka M, Suganuma N (2017). "Japanese workplace health management in pneumoconiosis prevention". J Occup Health. 59 (2): 91–103. doi:10.1539/joh.16-0031-RA. PMC 5478517. PMID 27980247.

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@@ Line 204: / Line 204: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
 |-
-| rowspan="12" |[[Respiratory system|'''Respiratory''']]
+| rowspan="12" style="background:#DCDCDC;" align="center" + |[[Respiratory system|'''Respiratory''']]
-|[[Upper respiratory tract|'''Upper airway diseases''']]
+| style="background:#DCDCDC;" align="center" + |[[Upper respiratory tract|'''Upper airway diseases''']]
 | style="background:#DCDCDC;" align="center" + |'''[[Common Cold Unit|Common Cold]]'''<ref name="pmid16253889">{{cite journal |vauthors=Eccles R |title=Understanding the symptoms of the common cold and influenza |journal=Lancet Infect Dis |volume=5 |issue=11 |pages=718–25 |year=2005 |pmid=16253889 |doi=10.1016/S1473-3099(05)70270-X |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Acute
@@ Line 453: / Line 453: @@
 * Children <2 years
 |-
-| rowspan="3" |[[Parenchyma|'''Parenchyma''']]
+| rowspan="3" style="background:#DCDCDC;" align="center" + |[[Parenchyma|'''Parenchyma''']]
 | style="background:#DCDCDC;" align="center" + |[[Pneumoconiosis|'''Pneumoconioses''']]<ref name="pmid27980247">{{cite journal |vauthors=Jp NA, Imanaka M, Suganuma N |title=Japanese workplace health management in pneumoconiosis prevention |journal=J Occup Health |volume=59 |issue=2 |pages=91–103 |year=2017 |pmid=27980247 |pmc=5478517 |doi=10.1539/joh.16-0031-RA |url=}}</ref><ref name="pmid12668748">{{cite journal |vauthors=Weiland DA, Lynch DA, Jensen SP, Newell JD, Miller DE, Crausman RS, Kuhn C, Kern DG |title=Thin-section CT findings in flock worker's lung, a work-related interstitial lung disease |journal=Radiology |volume=227 |issue=1 |pages=222–31 |year=2003 |pmid=12668748 |doi=10.1148/radiol.2271011063 |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Acute, Chronic
@@ Line 608: / Line 608: @@
 | style="background:#F5F5F5;" align="center" + | --
 |-
-| colspan="2" rowspan="4" |[[Autoimmune disease|'''Autoinmune''']]
+| colspan="2" rowspan="4" style="background:#DCDCDC;" align="center" + |[[Autoimmune disease|'''Autoinmune''']]
 | style="background:#DCDCDC;" align="center" + |[[Granulomatosis with polyangiitis|'''Wegener's disease''']] ([[Granulomatosis with polyangiitis|'''GPA''']]) <ref name="pmid1739240">{{cite journal |vauthors=Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS |title=Wegener granulomatosis: an analysis of 158 patients |journal=Ann. Intern. Med. |volume=116 |issue=6 |pages=488–98 |year=1992 |pmid=1739240 |doi= |url=}}</ref><ref name="pmid21374588">{{cite journal |vauthors=Falk RJ, Gross WL, Guillevin L, Hoffman GS, Jayne DR, Jennette JC, Kallenberg CG, Luqmani R, Mahr AD, Matteson EL, Merkel PA, Specks U, Watts RA |title=Granulomatosis with polyangiitis (Wegener's): an alternative name for Wegener's granulomatosis |journal=Arthritis Rheum. |volume=63 |issue=4 |pages=863–4 |year=2011 |pmid=21374588 |doi=10.1002/art.30286 |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Chronic