Differential Diagnosis for Shortness of Breath and Cough

Given the symptoms of shortness of breath and cough for 2 days in a patient with a history of asthma and bronchitis, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Asthma exacerbation: This is the most likely diagnosis given the patient's history of asthma. Asthma exacerbations can be triggered by various factors, including respiratory infections, allergens, or air pollutants, leading to increased symptoms of wheezing, cough, shortness of breath, and chest tightness.
• Other Likely Diagnoses
  • Acute bronchitis: Given the patient's history of bronchitis, an acute exacerbation is possible, especially if triggered by a viral or bacterial infection. Symptoms include cough, often productive of mucus, and possibly shortness of breath.
  • Pneumonia: Although less likely than asthma exacerbation or acute bronchitis, pneumonia should be considered, especially if the patient has been exposed to someone with a respiratory infection or has other risk factors. Symptoms can include cough, fever, shortness of breath, and chest pain.
  • Chronic obstructive pulmonary disease (COPD) exacerbation: If the patient has underlying COPD (which could be a progression of chronic bronchitis), an exacerbation could present with increased cough, sputum production, and shortness of breath.
• Do Not Miss Diagnoses
  • Pulmonary embolism: Although less common, pulmonary embolism is a life-threatening condition that can present with sudden onset of shortness of breath and cough. It's crucial to consider this diagnosis, especially if there are risk factors such as recent travel, immobility, or family history of clotting disorders.
  • Pneumothorax: Spontaneous pneumothorax can occur, especially in patients with underlying lung disease like asthma or COPD. Symptoms include sudden chest pain and shortness of breath.
  • Cardiac conditions (e.g., heart failure, myocardial infarction): These can present with shortness of breath and, less commonly, cough. It's essential to consider cardiac causes, especially if there are risk factors for heart disease.
• Rare Diagnoses
  • Cystic fibrosis exacerbation: If the patient has cystic fibrosis, an exacerbation could present with increased respiratory symptoms, including cough and shortness of breath, though this would be less likely without a known history of the disease.
  • Interstitial lung disease exacerbation: Conditions like sarcoidosis or idiopathic pulmonary fibrosis can cause cough and shortness of breath, but these would be less common without a pre-existing diagnosis.
  • Tuberculosis: Although rare in many areas, tuberculosis can present with chronic cough and shortness of breath. It's more likely to be considered if there's a history of exposure or travel to endemic areas.