Differential Diagnosis
- Single most likely diagnosis
- Chronic Obstructive Pulmonary Disease (COPD) exacerbation: The patient's history of smoking, persistent wheezing, and minimal improvement with bronchodilator therapy suggest a COPD exacerbation. The worsening of wheezing when laying down may indicate increased airway resistance.
- Other Likely diagnoses
- Acute Sinusitis: The patient's symptoms of nasal drainage, postnasal drainage, and sinus pressure, along with mild tenderness over the frontal sinuses, suggest acute sinusitis. The lack of significant improvement with antibiotics (Z-Pak) may indicate a viral or resistant bacterial infection.
- Asthma: The patient's wheezing, cough, and shortness of breath, particularly when laying down, could be indicative of asthma. The use of an albuterol inhaler suggests a diagnosis of asthma, but the patient's age and smoking history make COPD a more likely diagnosis.
- Allergic Rhinitis: The patient's symptoms of nasal drainage and sinus pressure could be related to allergic rhinitis, particularly if the patient has a history of allergies.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pneumonia: Although the patient's symptoms are more suggestive of an upper respiratory infection, pneumonia should be considered, particularly in a smoker with a history of respiratory disease.
- Lung Cancer: The patient's history of smoking and persistent respiratory symptoms warrant consideration of lung cancer, although this diagnosis is less likely given the patient's current presentation.
- Pulmonary Embolism: Although the patient's symptoms are not typical for pulmonary embolism, this diagnosis should be considered in any patient with unexplained respiratory symptoms, particularly if there are risk factors for thromboembolism.
- Rare diagnoses
- Cystic Fibrosis: Although rare in adults, cystic fibrosis could present with chronic respiratory symptoms, including wheezing and sinusitis.
- Bronchiectasis: This condition, characterized by permanent dilation of the bronchi, could present with chronic respiratory symptoms, including wheezing and cough.
- Relapsing Polychondritis: This rare autoimmune disorder could present with respiratory symptoms, including wheezing and sinusitis, although it is typically associated with other systemic symptoms.