Differential Diagnosis for a 50 year-old female patient with cough and chest tightness only with running

• Single most likely diagnosis
  • Exercise-induced bronchospasm (EIB): This condition is characterized by bronchospasm that occurs during or after exercise, leading to symptoms such as cough, chest tightness, and shortness of breath. It is a common condition in individuals without a history of asthma or other lung diseases, and running is a typical trigger.
• Other Likely diagnoses
  • Asthma: Although the patient has no known lung disease, asthma can sometimes be undiagnosed or misdiagnosed. Exercise can trigger asthma symptoms, including cough and chest tightness.
  • Vocal cord dysfunction (VCD): This condition involves abnormal movement of the vocal cords during inhalation, which can cause symptoms such as cough, chest tightness, and shortness of breath, particularly during exercise.
  • Gastroesophageal reflux disease (GERD): GERD can cause symptoms such as cough and chest tightness, especially during exercise, due to increased abdominal pressure and acid reflux.
• Do Not Miss diagnoses
  • Pulmonary embolism: Although less likely, pulmonary embolism is a life-threatening condition that can cause sudden onset of cough and chest tightness, especially with exertion. It is essential to consider this diagnosis, even if the patient has no known risk factors.
  • Cardiac conditions (e.g., coronary artery disease, hypertrophic cardiomyopathy): Although the patient has no known cardiac disease, it is crucial to consider cardiac conditions that can cause exertional symptoms, as they can be life-threatening if missed.
• Rare diagnoses
  • Churg-Strauss syndrome: A rare autoimmune disorder that can cause asthma-like symptoms, including cough and chest tightness, particularly during exercise.
  • Bronchiolitis obliterans: A rare lung condition that can cause symptoms such as cough and chest tightness, especially during exercise, due to inflammation and obstruction of the small airways.