Asthma differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "{{Asthma}} '''Editor(s)-in-Chief:''' C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Philip Marcus, M.D., M.P.H. [mailto:pmarcus192@aol.co...")
 
m (Bot: Removing from Primary care)
 
(23 intermediate revisions by 8 users not shown)
Line 1: Line 1:
{{Asthma}}
__NOTOC__
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Asthma]]
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com] {{AE}}


'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]
==Overview==
Asthma must be clinically differentiated from other conditions that cause recurrent cough and wheezing such as [[Bronchiolitis|viral bronchiolitis]], [[chronic obstructive pulmonary disease]], [[congestive heart failure]], [[Vocal cord paralysis|vocal cord dysfunction]], [[ACE inhibitors]] use and [[allergic rhinitis]].<ref name="pmid27180590">{{cite journal| author=Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY et al.| title=[The distribution characteristics of etiology of chronic cough in Lanzhou]. | journal=Zhonghua Jie He He Hu Xi Za Zhi | year= 2016 | volume= 39 | issue= 5 | pages= 362-7 | pmid=27180590 | doi=10.3760/cma.j.issn.1001-0939.2016.05.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27180590  }} </ref><ref name="pmid27112942">{{cite journal| author=Wrona W, Budka K, Filipiak KJ, Niewada M, Wojtyniak B, Zdrojewski T| title=Health outcomes and economic consequences of using angiotensin-converting enzyme inhibitors in comparison with angiotensin receptor blockers in the treatment of arterial hypertension in the contemporary Polish setting. | journal=Kardiol Pol | year= 2016 | volume= 74 | issue= 9 | pages= 1016-24 | pmid=27112942 | doi=10.5603/KP.a2016.0055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27112942  }} </ref>


==Differential Diagnosis==
==Differentiating Asthma from other Diseases==
Before diagnosing someone as asthmatic, [[differential diagnosis|alternative possibilities]] should be considered. A clinician taking a history should check whether the patient is using any known bronchoconstrictors (substances that cause narrowing of the airways, e.g., certain [[anti-inflammatory]] agents or [[beta-blockers]]).
*Asthma must be differentiated from other respiratory and cardiac diseases that can cause the same clinical manifestations like [[cough]] and [[dyspnea]]. These diseases include [[Bronchiolitis]], [[COPD]], [[pneumonia]], [[congestive heart failure]], diffuse idiopathic neuroendocrine cell hyperplasia, [[tuberculosis]], [[pertussis]], [[foreign body aspiration]], [[pulmonary embolism]] and [[Interstitial Pneumonia|Harmann-Rich syndrome]].<ref name="pmid27180590">{{cite journal| author=Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY et al.| title=[The distribution characteristics of etiology of chronic cough in Lanzhou]. | journal=Zhonghua Jie He He Hu Xi Za Zhi | year= 2016 | volume= 39 | issue= 5 | pages= 362-7 | pmid=27180590 | doi=10.3760/cma.j.issn.1001-0939.2016.05.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27180590  }} </ref><ref name="pmid28452705">{{cite journal| author=Lin L, Chen Z, Cao Y, Sun G| title=Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis. | journal=Am J Rhinol Allergy | year= 2017 | volume= 31 | issue= 2 | pages= 96-104 | pmid=28452705 | doi=10.2500/ajra.2017.31.4418 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28452705  }} </ref><ref name="pmid28454456">{{cite journal| author=Jiang S, Li J, Zeng Q, Liang J| title=Pulmonary artery intimal sarcoma misdiagnosed as pulmonary embolism: A case report. | journal=Oncol Lett | year= 2017 | volume= 13 | issue= 4 | pages= 2713-2716 | pmid=28454456 | doi=10.3892/ol.2017.5775 | pmc=5403205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28454456  }} </ref><ref name="pmid26169577">{{cite journal| author=Mosley JD, Shaffer CM, Van Driest SL, Weeke PE, Wells QS, Karnes JH et al.| title=A genome-wide association study identifies variants in KCNIP4 associated with ACE inhibitor-induced cough. | journal=Pharmacogenomics J | year= 2016 | volume= 16 | issue= 3 | pages= 231-7 | pmid=26169577 | doi=10.1038/tpj.2015.51 | pmc=4713364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26169577  }} </ref><ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref>


[[Chronic obstructive pulmonary disease]], which closely resembles asthma, is correlated with more exposure to cigarette smoke, an older patient, less symptom reversibility after bronchodilator administration (as measured by [[spirometry]]), and decreased likelihood of family history of [[atopy]].
{| class="wikitable"
! rowspan="2" |Diseases
! colspan="2" |Symptoms
!
! colspan="3" |Signs
! colspan="2" |Diagosis
|-
!Fever
!Cough
!Chest pain
!Wheezes
!Crackles
!Tachycardia
!Lab tests
!Imaging
|-
|[[Asthma]]
|<nowiki>-</nowiki>
|Dry/Productive
| -
|<nowiki>+</nowiki>
| -
| -
|
* Lab tests to exclude other [[Disease|diseases]]
* Serum examination shows elevated level of [[Eosinophil|eosinophils]] due to [[allergy]] 
|
* [[CT scan]] shows:
** Dilated [[bronchi]]
** Bronchial wall thickening
** Air trapping
|-
|[[Bronchiolitis]]
| +/-
|Dry
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| +
| +/-
|
* [[ELISA]] and [[immunoassays]] may be done in case of [[RSV]] [[infection]]
* [[Pulmonary function test]] to exclude other [[lung diseases]]<ref name="pmid18339530">{{cite journal| author=Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM et al.| title=An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. | journal=Respir Med | year= 2008 | volume= 102 | issue= 6 | pages= 825-30 | pmid=18339530 | doi=10.1016/j.rmed.2008.01.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18339530  }} </ref>
|
* [[CT scan]] shows:
** Intense [[Bronchiolar epithelium|bronchiolar]] mural [[inflammation]] 
** [[bronchial]] wall thickening
** Centrilobular [[nodules]] with tree-in-bud pattern 
|-
|[[COPD]]
|<nowiki>+</nowiki>
|Productive
|<nowiki>-</nowiki>
| +
| +
| +
|
* [[Spirometry]]: [[FEV1/FVC ratio|FEV1/FVC]] < 70%
* Arterial blood gases: [[hypoxemia]] and [[hypercapnia]]
* [[Sputum culture]] 
|
* EKG may show:
** [[P pulmonale]]
** [[right ventricular hypertrophy]]
** Narrow QRS<ref name="pmid23653989">{{cite journal| author=Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M| title=Analysis of electrocardiogram in chronic obstructive pulmonary disease patients. | journal=Med Pregl | year= 2013 | volume= 66 | issue= 3-4 | pages= 126-9 | pmid=23653989 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23653989  }} </ref>
* CT scan is more sensitive in diagnosing COPD than X ray 
|-
|[[Bacterial pneumonia]]  
|<nowiki>+</nowiki>
|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 (medicine)|Consolidation]]
** Ground glass appearance
|-
|[[Pulmonary embolism]]
| +/-
|Bloody
| +
| +
| +
| +
|
* Arterial blood gases may show:<ref name="pmid2491801">{{cite journal |author=Cvitanic O, Marino PL |title=Improved use of arterial blood gas analysis in suspected pulmonary embolism |journal=[[Chest]] |volume=95 |issue=1 |pages=48–51 |year=1989 |month=January |pmid=2491801 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=2491801 |accessdate=2012-04-30}}</ref>
**[[Hypoxemia]]
**[[Hypocapnia]]
**[[Respiratory alkalosis]]
**Increased alveolar-arterial gradient
*[[D-dimer]] assay to rule out other diseases like [[DVT]]
* [[Hypercoagulability]] tests for patients with:
** Unprovoked [[venous thrombosis]] at an early age (< 40 years)
** Family history of [[VTE]] syndromes
*Routine blood tests are non specific
|
* CT [[pulmonary angiography]] is the gold standard imaging to diagnose pulmonary embolism. CT may show:
**Acute:Centrally located [[thrombus]] occluding the vessel
**Chronic:Eccentric changes in the [[vessel wall]], recanalization in the thrombous and arterial web
* EKG is not specific or sensitive in PE diagnosis but it may show:
** [[T wave inversion]]
** [[P pulmonale]]
** [[sinus tachycardia]]
* Chest X ray to exclude other differentials
|-
|Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia<ref name="pmid21471097">{{cite journal| author=Nassar AA, Jaroszewski DE, Helmers RA, Colby TV, Patel BM, Mookadam F| title=Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a systematic overview. | journal=Am J Respir Crit Care Med | year= 2011 | volume= 184 | issue= 1 | pages= 8-16 | pmid=21471097 | doi=10.1164/rccm.201010-1685PP | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21471097  }} </ref>
| -
|Dry
| -
| +
| -
| -
|
* Pulmonary function test shows obstructive lung disease
|
* CT scan may show:
** Multiple [[nodules]]
** [[Ground glass opacification on CT|Ground glass]] appearance
** [[Bronchiectasis]].
|-
|[[Tuberculosis]]
| +
|Bloody
| +
| -
| -
| -
|
* Sputum culture:
** Three successive positive culture for [[Mycobacterium tuberculosis|M. tuberculosis]] confirms the diagnosis<ref name="pmid12614730">{{cite journal |author=Drobniewski F, Caws M, Gibson A, Young D |title=Modern laboratory diagnosis of tuberculosis |journal=Lancet Infect Dis |volume=3 |issue=3 |pages=141-7 |year=2003 |id=PMID 12614730}}</ref>
** Presence of acid fast bacilli in sputum smear indicates high extent tuberculosis
|
* Chest X ray is an important diagnostic imaging procedure in TB diagnosis. X ray may show:<ref>{{Cite journal
| author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]]
| title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review
| journal = [[The Journal of rheumatology. Supplement]]
| volume = 91
| pages = 32–40
| year = 2014
| month = May
| doi = 10.3899/jrheum.140100
| pmid = 24788998
}}</ref>
** Parenchymal infilration
** Hilar [[adenopathy]]
**[[Nodules]]
**[[Pleural effusion (patient information)|Pleural effusion]]


[[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.
* CT scan may show:<ref>{{Cite journal
| author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]]
| title = Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging
| journal = [[Chest]]
| year = 2014
| month = June
| doi = 10.1378/chest.14-0196
| pmid = 25086249
}}</ref>
** Micronodules
** [[Cavitation]]
** [[Consolidation (medicine)|Consolidation]]
**Interlobular septal thickening
*EKG may have abnormalities in case pleural effussion associated with TB.  


A majority of children who are asthma sufferers have an identifiable [[allergy]] trigger. Specifically, in a 2004 study, 71% had positive test results for more than 1 allergen, and 42% had positive test results for more than 3 allergens.<ref>{{cite journal |last=Vargas |first=PA |title=Characteristics of children with asthma who are enrolled in a Head Start program |url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15356547&query_hl=23&itool=pubmed_docsum |journal= J Allergy Clin Immunol |date=September 2004 |pages=499–504 |pmid=15356547 }}</ref>
|-
|[[Hamman-Rich syndrome|Interstitial pneumonitis]] (Hamman - Rich syndrome)
|<nowiki>+</nowiki>
|Productive
| -
| -
| +
| -
|
* Arterial blood gases may show:
** [[hypoxemia]]
** PaO2/FiO2 less than 200 mmHg indicating [[acute respiratory distress syndrome]]
* Other lab tests are done to exclude other diseases
|
* Chest X ray may show:
** Bilateral airway opacification
* CT scan may show
** [[Ground glass opacification on CT|Ground glass]] appearance.
* [[Bronchoscopy]] to exclude other causes such as:
** [[alveolar]] [[hemorrhage]]
** [[lymphoma]].
* Lung biopsy is done:
** In unclear cases; to confirm [[Interstitial pneumonitis|acute interstitial pneumonitis]]
** Exclude other causes of [[Acute respiratory distress syndrome|ARDS]]
|-
|[[Foreign body aspiration]]
| +
|Bloody
|<nowiki>+</nowiki>
| +
| -
| -
|
* Lab tests to evaluate the [[ventilation]] function
|
* Chest X ray shows:
** Hyperinflation
** Mediastinal shift 
** [[atelectasis|Aatelectasis]]
|-
|[[Pertussis]]
| +
|Dry
|
| -
| -
| -
|
* Nasopharyngeal swab for [[Polymerase chain reaction|PCR testing]]
* [[Sputum culture]]
* Serology to detect [[pertussis toxin]]<ref name="CDC4">[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 22, 2017]</ref><ref name="CDC3">[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html Pertussis (whooping cough). Specimen collection. CDC.gov. Accessed on June 22, 2017] </ref>
|
* No remarkable imaging findings
|-
|[[Congestive heart failure]]
| -
|Dry/Productive
|<nowiki>+ while walking </nowiki>
| -
| -
| +
|
*Routine lab tests to identify the cause of the [[heart failure]]:
**Renal function tests including [[urinalysis]] and [[Electrolyte|electrolytes]]
**[[Complete blood count]]
**[[Thyroid]] studies in patients being treated with concomitant therapy such as [[amiodarone]]
*Biomarkers:
**[[BNP]] or [[NT-proBNP]]<ref name="pmid23747642">{{cite journal |vauthors=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 |title=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 |journal=J. Am. Coll. Cardiol. |volume=62 |issue=16 |pages=e147–239 |year=2013 |pmid=23747642 |doi=10.1016/j.jacc.2013.05.019 |url=}}</ref>
**Cardiac Troponin T or I
**Carbohydrate Antigen 125<ref name="pmid27810078">{{cite journal| author=D'Aloia A, Vizzardi E, Metra M| title=Can Carbohydrate Antigen-125 Be a New Biomarker to Guide Heart Failure Treatment?: The CHANCE-HF Trial. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 11 | pages= 844-846 | pmid=27810078 | doi=10.1016/j.jchf.2016.09.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27810078  }} </ref>
|
* EKG to detect underlying cause
* Chest x ray shows cardiomegaly
* Echocardiography is done:
** To determine [[stroke volume]]
** To assess type of heart failure<ref name="pmid19700135">{{cite journal |vauthors=Agha SA, Kalogeropoulos AP, Shih J, Georgiopoulou VV, Giamouzis G, Anarado P, Mangalat D, Hussain I, Book W, Laskar S, Smith AL, Martin R, Butler J |title=Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers |journal=J. Card. Fail. |volume=15 |issue=7 |pages=586–92 |year=2009 |pmid=19700135 |doi=10.1016/j.cardfail.2009.03.002 |url=}}</ref>
|}


The majority of these triggers can often be identified from the history; for instance, asthmatics with [[hay fever]] or pollen allergy will have seasonal symptoms, those with allergies to pets may experience an abatement of symptoms when away from home, and those with [[occupational asthma]] may improve during leave from work. Occasionally, [[allergy#Diagnosis|allergy tests]] are warranted and, if positive, may help in identifying avoidable symptom triggers.  
* Although, many cases of recurrent cough and wheezing in children and adults are due to asthma, other conditions are often misdiagnosed as asthma.<ref name="pmid27180590">{{cite journal| author=Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY et al.| title=[The distribution characteristics of etiology of chronic cough in Lanzhou]. | journal=Zhonghua Jie He He Hu Xi Za Zhi | year= 2016 | volume= 39 | issue= 5 | pages= 362-7 | pmid=27180590 | doi=10.3760/cma.j.issn.1001-0939.2016.05.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27180590  }} </ref><ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref><ref name="pmid26169577">{{cite journal| author=Mosley JD, Shaffer CM, Van Driest SL, Weeke PE, Wells QS, Karnes JH et al.| title=A genome-wide association study identifies variants in KCNIP4 associated with ACE inhibitor-induced cough. | journal=Pharmacogenomics J | year= 2016 | volume= 16 | issue= 3 | pages= 231-7 | pmid=26169577 | doi=10.1038/tpj.2015.51 | pmc=4713364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26169577  }} </ref><ref name="pmid28454456">{{cite journal| author=Jiang S, Li J, Zeng Q, Liang J| title=Pulmonary artery intimal sarcoma misdiagnosed as pulmonary embolism: A case report. | journal=Oncol Lett | year= 2017 | volume= 13 | issue= 4 | pages= 2713-2716 | pmid=28454456 | doi=10.3892/ol.2017.5775 | pmc=5403205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28454456  }} </ref><ref name="pmid28452705">{{cite journal| author=Lin L, Chen Z, Cao Y, Sun G| title=Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis. | journal=Am J Rhinol Allergy | year= 2017 | volume= 31 | issue= 2 | pages= 96-104 | pmid=28452705 | doi=10.2500/ajra.2017.31.4418 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28452705  }} </ref>
===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 ([[Lung cancer|benign and malignant tumors]])
*[[Pulmonary]] infiltration with [[eosinophilia]]
*[[Diffuse parenchymal lung disease|Diffuse parenchymal lung diseases]]
*[[Cough]], secondary to drugs ([[ACE inhibitor|ACE inhibitors]])<ref name="pmid27112942">{{cite journal| author=Wrona W, Budka K, Filipiak KJ, Niewada M, Wojtyniak B, Zdrojewski T| title=Health outcomes and economic consequences of using angiotensin-converting enzyme inhibitors in comparison with angiotensin receptor blockers in the treatment of arterial hypertension in the contemporary Polish setting. | journal=Kardiol Pol | year= 2016 | volume= 74 | issue= 9 | pages= 1016-24 | pmid=27112942 | doi=10.5603/KP.a2016.0055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27112942  }} </ref>
*[[Vocal cord paralysis|Vocal cord dysfunction]]<ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref>
*[[Pharyngitis]]


After a [[pulmonary function test]] has been carried out, radiological tests, such as a [[chest X-ray]] or [[computed tomography|CT scan]], may be required to exclude the possibility of other lung diseases. In some people, asthma may be triggered by [[gastroesophageal reflux disease]], which can be treated with suitable [[antacid]]s. Very occasionally, specialized tests after inhalation of [[methacholine challenge test|methacholine]] — or, even less commonly, [[histamine]] — may be performed.
===Infants & Children===
=====Upper airway diseases=====
*[[Allergic rhinitis]] and [[sinusitis]]<ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref>


Asthma is categorized by the United States [[National Heart, Lung and Blood Institute]] as falling into one of four categories: intermittent, mild persistent, moderate persistent and severe persistent. The diagnosis of "severe persistent asthma" occurs when symptoms are continual with frequent exacerbations and frequent nighttime symptoms, result in limited physical activity and when lung function as measured by PEV or FEV<sub>1</sub> tests is less than 60% predicted with PEF variability greater than 30%.
=====Obstructions involving large airways=====
*[[Foreign body in respiratory tract|Foreign body in trachea or bronchus]]
*[[Vocal cord paralysis|Vocal cord dysfunction]]
*[[Vascular ring|Vascular rings]] or laryngeal webs
*[[Laryngotracheomalacia]], tracheal stenosis, or bronchostenosis
*[[Lymphadenopathy|Enlarged lymph nodes]] or [[Lung cancer|tumor]]<ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref>
 
=====Obstructions involving small airways=====
*[[Bronchiolitis|Viral bronchiolitis]] or [[Bronchiolitis obliterans|obliterative bronchiolitis]]
*[[Cystic fibrosis]]
*[[Bronchopulmonary dysplasia]]<ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref>
 
=====Other causes=====
*[[Congenital heart disease|Congenital heart diseases]]
*Recurrent [[cough]] not due to asthma
*[[Aspiration]] from swallowing mechanism
*[[Gastroesophageal reflux]]<ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Immunology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Mature chapter]]
 
{{WH}}
{{WS}}

Latest revision as of 20:30, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2] Associate Editor(s)-in-Chief:

Overview

Asthma must be clinically differentiated from other conditions that cause recurrent cough and wheezing such as viral bronchiolitis, chronic obstructive pulmonary disease, congestive heart failure, vocal cord dysfunction, ACE inhibitors use and allergic rhinitis.[1][2]

Differentiating Asthma from other Diseases

Diseases Symptoms Signs Diagosis
Fever Cough Chest pain Wheezes Crackles Tachycardia Lab tests Imaging
Asthma - Dry/Productive - + - -
Bronchiolitis +/- Dry - + + +/-
COPD + Productive - + + +
Bacterial pneumonia + Productive + + + +/-
Pulmonary embolism +/- Bloody + + + +
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia[10] - Dry - + - -
  • Pulmonary function test shows obstructive lung disease
Tuberculosis + Bloody + - - -
  • Sputum culture:
    • Three successive positive culture for M. tuberculosis confirms the diagnosis[11]
    • Presence of acid fast bacilli in sputum smear indicates high extent tuberculosis
  • CT scan may show:[13]
  • EKG may have abnormalities in case pleural effussion associated with TB.
Interstitial pneumonitis (Hamman - Rich syndrome) + Productive - - + -
Foreign body aspiration + Bloody + + - -
  • Chest X ray shows:
Pertussis + Dry - - -
  • No remarkable imaging findings
Congestive heart failure - Dry/Productive + while walking - - +
  • EKG to detect underlying cause
  • Chest x ray shows cardiomegaly
  • Echocardiography is done:
  • Although, many cases of recurrent cough and wheezing in children and adults are due to asthma, other conditions are often misdiagnosed as asthma.[1][6][5][4][3]

Adults

Infants & Children

Upper airway diseases
Obstructions involving large airways
Obstructions involving small airways
Other causes

References

  1. ↑ 1.0 1.1 1.2 Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY; et al. (2016). "[The distribution characteristics of etiology of chronic cough in Lanzhou]". Zhonghua Jie He He Hu Xi Za Zhi. 39 (5): 362–7. doi:10.3760/cma.j.issn.1001-0939.2016.05.006. PMID 27180590.
  2. ↑ 2.0 2.1 Wrona W, Budka K, Filipiak KJ, Niewada M, Wojtyniak B, Zdrojewski T (2016). "Health outcomes and economic consequences of using angiotensin-converting enzyme inhibitors in comparison with angiotensin receptor blockers in the treatment of arterial hypertension in the contemporary Polish setting". Kardiol Pol. 74 (9): 1016–24. doi:10.5603/KP.a2016.0055. PMID 27112942.
  3. ↑ 3.0 3.1 Lin L, Chen Z, Cao Y, Sun G (2017). "Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis". Am J Rhinol Allergy. 31 (2): 96–104. doi:10.2500/ajra.2017.31.4418. PMID 28452705.
  4. ↑ 4.0 4.1 Jiang S, Li J, Zeng Q, Liang J (2017). "Pulmonary artery intimal sarcoma misdiagnosed as pulmonary embolism: A case report". Oncol Lett. 13 (4): 2713–2716. doi:10.3892/ol.2017.5775. PMC 5403205. PMID 28454456.
  5. ↑ 5.0 5.1 Mosley JD, Shaffer CM, Van Driest SL, Weeke PE, Wells QS, Karnes JH; et al. (2016). "A genome-wide association study identifies variants in KCNIP4 associated with ACE inhibitor-induced cough". Pharmacogenomics J. 16 (3): 231–7. doi:10.1038/tpj.2015.51. PMC 4713364. PMID 26169577.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ Cvitanic O, Marino PL (1989). "Improved use of arterial blood gas analysis in suspected pulmonary embolism". Chest. 95 (1): 48–51. PMID 2491801. Retrieved 2012-04-30. Unknown parameter |month= ignored (help)
  10. ↑ Nassar AA, Jaroszewski DE, Helmers RA, Colby TV, Patel BM, Mookadam F (2011). "Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a systematic overview". Am J Respir Crit Care Med. 184 (1): 8–16. doi:10.1164/rccm.201010-1685PP. PMID 21471097.
  11. ↑ Drobniewski F, Caws M, Gibson A, Young D (2003). "Modern laboratory diagnosis of tuberculosis". Lancet Infect Dis. 3 (3): 141–7. PMID 12614730.
  12. ↑ Riccardo Piccazzo, Francesco Paparo & Giacomo Garlaschi (2014). "Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review". The Journal of rheumatology. Supplement. 91: 32–40. doi:10.3899/jrheum.140100. PMID 24788998. Unknown parameter |month= ignored (help)
  13. ↑ Jeong Min Ko, Hyun Jin Park & Chi Hong Kim (2014). "Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging". Chest. doi:10.1378/chest.14-0196. PMID 25086249. Unknown parameter |month= ignored (help)
  14. ↑ Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 22, 2017
  15. ↑ Pertussis (whooping cough). Specimen collection. CDC.gov. Accessed on June 22, 2017
  16. ↑ 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". J. Am. Coll. Cardiol. 62 (16): e147–239. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  17. ↑ D'Aloia A, Vizzardi E, Metra M (2016). "Can Carbohydrate Antigen-125 Be a New Biomarker to Guide Heart Failure Treatment?: The CHANCE-HF Trial". JACC Heart Fail. 4 (11): 844–846. doi:10.1016/j.jchf.2016.09.001. PMID 27810078.
  18. ↑ Agha SA, Kalogeropoulos AP, Shih J, Georgiopoulou VV, Giamouzis G, Anarado P, Mangalat D, Hussain I, Book W, Laskar S, Smith AL, Martin R, Butler J (2009). "Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers". J. Card. Fail. 15 (7): 586–92. doi:10.1016/j.cardfail.2009.03.002. PMID 19700135.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Asthma_differential_diagnosis&oldid=1634929"