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
- Before diagnosing someone with asthma, alternative possibilities should be considered.
- 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.
- Chronic obstructive pulmonary disease, which closely resembles asthmatic symptoms, is correlated with:
- More exposure to cigarette smoke
- An older patient
- Less symptom reversibility after bronchodilator administration (as measured by spirometry)
- Decreased likelihood of family history of atopy
- 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.