Differential Diagnosis for Nocturnal Asthma

The patient's symptoms of shortness of breath (SOB) and wheezing that wake them up every night suggest a type of asthma that is exacerbated at night. Here is a differential diagnosis organized into categories:

• Single Most Likely Diagnosis
  • Nocturnal Asthma: This is the most likely diagnosis, as the patient's symptoms are consistent with asthma that worsens at night, often due to increased airway inflammation, bronchospasm, or exposure to allergens during sleep.
• Other Likely Diagnoses
  • Chronic Asthma with Poor Control: The patient may have chronic asthma that is not well-controlled, leading to persistent symptoms, including nocturnal worsening.
  • Allergic Asthma: Allergens such as dust mites, pet dander, or mold in the bedroom may trigger or exacerbate asthma symptoms at night.
• Do Not Miss Diagnoses
  • Chronic Obstructive Pulmonary Disease (COPD): Although less likely, COPD can present with similar symptoms, and missing this diagnosis could lead to delayed treatment and poor outcomes.
  • Heart Failure: Nocturnal dyspnea (shortness of breath) can be a symptom of heart failure, which would be a critical diagnosis not to miss.
  • Pulmonary Embolism: Although rare, pulmonary embolism can cause sudden onset of dyspnea and wheezing, and is a potentially life-threatening condition that must be considered.
• Rare Diagnoses
  • Vocal Cord Dysfunction: A rare condition that can mimic asthma, characterized by abnormal vocal cord movement, leading to wheezing and shortness of breath.
  • Gastroesophageal Reflux Disease (GERD)-Induced Asthma: GERD can trigger asthma symptoms, including nocturnal worsening, in some patients.