Asthma differential diagnosis

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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