Differential Diagnosis
The patient's symptoms of persistent cough, wheezing, and shortness of breath, particularly at night, along with a history of asthma and lack of response to typical asthma treatments, suggest a complex respiratory condition. The following differential diagnoses are considered:
- Single most likely diagnosis
- Asthma exacerbation or poorly controlled asthma: Given the patient's history of asthma and the presence of wheezing, cough, and shortness of breath, it is possible that her asthma is not well-controlled or has exacerbated. The fact that symptoms worsen at night and with lying down also supports this diagnosis.
- Other Likely diagnoses
- Gastroesophageal reflux disease (GERD): GERD can cause respiratory symptoms such as cough and wheezing, especially at night, due to acid reflux into the lungs. The patient's symptoms worsening when lying down support this diagnosis.
- Allergic rhinitis or sinusitis: Allergies can trigger respiratory symptoms, and the patient's recent move to a new location may have exposed her to new allergens. The persistent cough and wheezing could be related to allergic reactions.
- Environmental or occupational exposure: The patient's symptoms started after moving to a new location, suggesting possible exposure to environmental or occupational allergens or irritants.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although less likely, pulmonary embolism can cause sudden onset of shortness of breath and wheezing. Normal oxygen saturation does not rule out this diagnosis.
- Cardiac disease (e.g., heart failure): Cardiac conditions can cause shortness of breath, wheezing, and cough, especially when lying down. A thorough cardiac evaluation is necessary to rule out this possibility.
- Pneumonia or other infections: Infections can cause persistent cough and wheezing, and it is essential to consider this possibility, especially if the patient has not responded to asthma treatment.
- Rare diagnoses
- Vocal cord dysfunction: This condition can cause wheezing and shortness of breath, especially when lying down. It is often misdiagnosed as asthma.
- Eosinophilic pneumonia: A rare condition characterized by inflammation of the lungs due to eosinophils, which can cause respiratory symptoms.
- Hypersensitivity pneumonitis: A rare lung disease caused by an allergic reaction to inhaled substances, which can cause respiratory symptoms and worsening of symptoms when exposed to the allergen.