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
- Asthma: The patient's wheezing, cough, and shortness of breath could be indicative of asthma, especially with the use of an albuterol inhaler. However, the lack of significant improvement with bronchodilator therapy and the patient's age make COPD more likely.
- Acute Sinusitis: The patient's symptoms of nasal drainage, postnasal drainage, and sinus pressure, as well as the mild tenderness over the frontal sinuses, suggest acute sinusitis. However, the minimal improvement with antibiotics (Z-Pak) and steroids (prednisone) makes this diagnosis less likely.
- Chronic Bronchitis: The patient's chronic cough, wheezing, and smoking history could be indicative of chronic bronchitis, which is often seen in conjunction with COPD.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pneumonia: Although the patient's symptoms have been present for some time, pneumonia should always be considered, especially in a smoker with persistent respiratory symptoms. A chest X-ray would be necessary to rule out pneumonia.
- Lung Cancer: The patient's smoking history and persistent respiratory symptoms warrant consideration of lung cancer, although it is less likely given the patient's current symptoms and lack of significant weight loss or other systemic symptoms.
- Pulmonary Embolism: Although the patient's symptoms do not strongly suggest pulmonary embolism, it should always be considered in patients with persistent respiratory symptoms, especially if there are any signs of acute distress or hypoxia.
- Rare diagnoses
- Cystic Fibrosis: Although rare in adults, cystic fibrosis could present with chronic respiratory symptoms, including wheezing and cough. However, the patient's age and lack of other systemic symptoms make this diagnosis unlikely.
- Alpha-1 Antitrypsin Deficiency: This rare genetic disorder can cause COPD-like symptoms in adults, but it is less likely given the patient's smoking history and lack of other systemic symptoms.
- Allergic Bronchopulmonary Aspergillosis (ABPA): This rare condition can cause chronic respiratory symptoms, including wheezing and cough, in patients with asthma or COPD. However, the patient's lack of other systemic symptoms and the absence of any mention of allergic reactions make this diagnosis unlikely.