Consider a differential diagnosis – ICST

Consider a differential diagnosis

COPD is a common condition and when an individual presents with with symptoms it is easy to jump to a diagnostic conclusion. There are many people with misdiagnosis of COPD, who may be breathless for other reasons.

Consider a differential diagnosis of Asthma in patients:

  • commonly develops symptoms under age 35 years old
  • chronic productive cough is uncommon
  • beathlessness is variable
  • night-time waking with breathlessness and/or wheeze is common
  • significant diurnal or day-to-day variability of symptoms is common

Consider a differential diagnosis of Congestive Heart Failure in patients:

  • wheezing
  • history of orthopnoea
  • paroxysmal nocturnal dyspnea
  • fine basal crackles on chest auscultation

Consider a differential diagnosis of Bronchiectasis in patients:

  • chronic production of copious purulent sputum
  • coarse crackles
  • finger clubbing on physical examination

Consider a differential diagnosis of Alpha-1-Antitrypsin Deficiency in patients:

  • symptoms and significant airflow obstructive abnormalities before 40 years
  • Liver disease in adults (manifesting as cirrhosis and fibrosis)

Consider a differential diagnosis of Lung Cancer in patients:

  • cough
  • dyspnoea
  • chest pain
  • haemoptysis


Among patients who present in mid or later life with breathlessness, cough, and sputum production, the differential diagnosis is broad (eg, heart failure, COPD, interstitial lung disease, thromboembolic disease). Typically, the finding of persistent airflow limitation on spirometry, and the absence of radiographic features of heart failure or interstitial lung disease, direct the clinician to a narrower diagnosis. Importantly, these conditions can commonly occur together, for example, patients with asthma may develop COPD and patients with COPD may have concurrent bronchiectasis.

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