Differential Diagnosis

The patient presents with a cough of 1/12 duration, worsening recently, with associated symptoms of runny nose, sneezing, itchy throat, and swollen tonsils. The patient has a history of asthma and is on Symbicort, which has been less effective lately. Here is the differential diagnosis, categorized for clarity:

• Single Most Likely Diagnosis
  • Asthma Exacerbation: The patient's history of asthma, recent worsening of symptoms, and decreased effectiveness of Symbicort suggest an asthma exacerbation. The presence of wheeze on examination further supports this diagnosis.
• Other Likely Diagnoses
  • Upper Respiratory Tract Infection (URTI): The patient's symptoms of cough, runny nose, sneezing, and itchy throat, which started after a flu-like illness, are consistent with a URTI. The swollen tonsils also support this diagnosis.
  • Allergic Rhinitis: The patient's symptoms of sneezing, runny nose, and itchy throat, particularly if worsening at night, could be indicative of allergic rhinitis, possibly exacerbated by environmental allergens.
• Do Not Miss Diagnoses
  • Pneumonia: Although the patient's chest is clear on auscultation, pneumonia should be considered, especially given the recent travel history and worsening symptoms. A chest X-ray may be necessary to rule out this diagnosis.
  • Pertussis (Whooping Cough): The patient's persistent cough, which has worsened over time, could be suggestive of pertussis, especially if the patient has not been vaccinated or has been in contact with someone with the disease.
• Rare Diagnoses
  • Bronchiectasis: This condition, characterized by permanent dilation of parts of the airways, could be considered if the patient's symptoms persist despite adequate treatment of asthma and other conditions. However, it would be less likely without additional symptoms such as chronic sputum production.
  • Interstitial Lung Disease: Although rare, interstitial lung disease could be a consideration if the patient's symptoms and radiographic findings (if a chest X-ray or CT scan is performed) suggest an inflammatory or fibrotic process affecting the lung interstitium.