Differential Diagnosis of COPD
Diagnosis Suggestive Features for Differential Diagnosis of COPD:
COPD
- Onset in mid-life
- Symptoms slowly progressive
- Long smoking history
- Dyspnea during exercise
- Largely irreversible airflow limitation
Asthma
- Onset early in life (often childhood)
- Symptoms vary from day to day
- Symptoms at night/early morning
- Allergy/rhinitis and/or eczema also present
- Family history of asthma
- Largely reversible airflow limitation
Congestive Heart Failure
- Fine basilar crackles on auscultation
- Chest X-ray shows dilated heart, pulmonary edema
- Pulmonary function tests indicated volume restriction, not airflow limitation
Bronchiectasis
- Large volumes of purulent sputum
- Commonly associated with bacterial infection
- Coarse crackles/clubbing on auscultation
- Chest X-ray/computed tomography (CT) shows bronchial dilation, bronchial wall-thickening
Tuberculosis
- Onset all ages
- Chest X-ray shows lung infiltrate
- Microbiological confirmation
- High local prevalence of tuberculosis
Obliterative Bronchiolitis
- Onset in younger-aged nonsmokers
- May have history of rheumatoid arthritis or toxic fume exposure
- CT on expiration shows hypodense areas
Diffuse Panbronchiolitis
- Most patients are male and nonsmokers
- Almost all have chronic sinusitis
- Chest X-ray and high-resolution CT show diffuse, small centrilobular nodular opacities and hyperinflation
Asthma & COPDOf these potential differential diagnoses, asthma is the most difficult to determine. As we have learned, COPD and asthma are 2 distinct clinical conditions, yet there are significant overlaps in signs and symptoms between the 2 diseases. |
Chronic Bronchitis & COPDChronic bronchitis is an inflammatory, irritable obstructive airways disease characterized by excessive mucus secretion that causes a productive cough lasting at least 3 months of the year for 2 consecutive years. |
Emphysema & COPDThe British Thoracic Society guidelines define emphysema as "a permanent destructive enlargement of the air spaces distal to the terminal bronchioles." It is characterized by the breakdown of the walls of the alveoli and the capillaries that surround them. |
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