5th January 2024

Differential Diagnosis

Congestive heart failure (CHF)- may present with wheeze and could be difficult to differentiate from emphysema. History of orthopnea, paroxysmal nocturnal dyspnea and fine basal crackles on examination can point toward CHF.
Bronchiectasis- distinguishing signs and symptoms include chronic cough productive of copious and purulent sputum, coarse crackles and possible finger clubbing (COPD alone does not have clubbing).
Bronchiolitis obliterans- an inflammatory disease which involves both the alveoli and peripheral bronchioles. It is usually observed in younger patients with no smoking history and patients with collagen-vascular diseases. A chest CT scan might show areas of mosaic attenuation without signs of generalised emphysema.
Asthma- COPD may be difficult to distinguish from delayed onset of severe asthma. However, there is significant bronchodilator response on pulmonary function tests.
Chronic cough induced by ACE-inhibitors- ACE inhibitors may cause chronic non-productive cough, which improves upon cessation of the medications.
Gastro-oesophageal reflux disease- can cause chronic cough that might worsen at night when supine. Symptoms improve with proton pump inhibitors.
Chronic sinusitis and post nasal drip- chronic sinusitis or rhinitis is a common cause of chronic cough. Other symptoms include headache, facial pain and rhinorrhoea. CT of sinuses, nasal endoscopy, and antihistamine aid in diagnosis.

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