Bronchiectasis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
Bronchiectasis should be differentiated from other diseases that cause dyspnea and cough, such as COPD, asthma, pneumonia, tuberculosis, chronic sinusitis, cough due to gastrointestinal reflux, upper airway cough syndrome, pulmonary carcinoma, and inhaled foreign body.
Bronchiectasis Differential Diagnosis
The following table lists the most common differential diagnoses of bronchiectasis:
| Differential Diagnosis | Description |
|---|---|
| Chronic obstructive pulmonary disease (COPD) | Diminished breath sounds in COPD are not found in bronchiectasis; chest CT will be normal or show emphysema is patients with COPD |
| Asthma | Crackles found in bronchiectasis will not be found in asthma, airflow obstruction is reversible in asthma |
| Pneumonia | Patients with pneumonia will express symptoms for a short duration of 7-10 days, whereas patients with bronchiectasis express symptoms for years; patients with pneumonia have bronchial breath sounds on auscultation; consolidation is seen on chest x-ray and chest CT in patients with pneumonia |
| Tuberculosis | CT will show Upper lobe consolidations or cavities in TB but not in bronchiectasis |
| Chronic sinusitis | Crackles found in bronchiectasis will not be found in chronic sinusitis; chest x-ray and chest CT are normal in chronic sinusitis |
| Cough due to gastrointestinal reflux (GERD) | The cough can be alleviated by antacids, proton pump inhibitors (PPI), or H2 blockers in GERD but not bronchiectasis |
| Upper airway cough syndrome (postnasal drip) | The cough can be alleviated by antihistamines or decongestants in upper airway syndrome but not bronchiectasis |
| Pulmonary carcinoma | These patients have similar symptoms to patients with bronchiectasis; they usually have a history of smoking and symptoms due to pressure from adjacent structures such as chest pain, bone pain, and difficulty in swallowing; diagnosis can be made via a chest radiograph or CT scan |
| Inhaled foreign body | These patients will have a sudden onset of cough, wheeze, and decreased breath sounds whereas bronchiectasis patients develop these symptoms for months/years |
Features that may suggest bronchiectasis in a patient presenting with chronic respiratory symptoms
- Digital clubbing
- Lack of a significant smoking history if you suspect a patient has COPD
- History of recurrent and/or severe pneumonia or tuberculosis
- Presence of Aspergillus, atypical/nontuberculous mycobacteria, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae in the sputum
- If the childhood is associated with significant environmental and social disadvantage