Differential Diagnosis for a 14-year-old Boy with Chest Tightness and Wheezing
- Single most likely diagnosis:
- Mild persistent asthma: This classification is the most appropriate given the patient's symptoms of daily intermittent chest tightness and wheezing, limitation of physical activity, and nocturnal symptoms 2 nights per week. The FEV1 of 70% of predicted and physical examination findings support this diagnosis.
- Other Likely diagnoses:
- Moderate persistent asthma: Although the patient's symptoms and FEV1 could also suggest moderate persistent asthma, the description provided leans more towards mild persistent given the frequency and impact of symptoms.
- Exercise-induced asthma: This could be considered given the patient's symptoms during physical education class. However, the presence of daily and nocturnal symptoms suggests a more persistent form of asthma rather than one solely induced by exercise.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Severe persistent asthma: Although less likely given the patient's current level of symptoms and FEV1, severe persistent asthma must be considered due to its potential for life-threatening exacerbations.
- Other respiratory conditions (e.g., cystic fibrosis, bronchiectasis): These conditions could present with similar symptoms and must be ruled out, especially if the patient does not respond to standard asthma treatment.
- Rare diagnoses:
- Vocal cord dysfunction: This condition can mimic asthma symptoms and should be considered if the patient does not respond to typical asthma management.
- Cardiac causes of wheezing and chest tightness (e.g., cardiac asthma): Although rare, cardiac conditions can present with symptoms similar to asthma, especially in the context of exertion or at night.