Differential Diagnosis for Conditions that Mimic Chronic Asthma

• Single most likely diagnosis
  • Chronic obstructive pulmonary disease (COPD): This condition is the most likely to mimic chronic asthma due to similar symptoms such as wheezing, coughing, and shortness of breath. The key difference lies in the reversibility of airflow limitation, which is typically seen in asthma but not in COPD.
• Other Likely diagnoses
  • Allergic rhinitis: Often coexists with asthma and can cause similar respiratory symptoms, making it a likely consideration in the differential diagnosis.
  • Vocal cord dysfunction: Can present with symptoms similar to asthma, such as wheezing and shortness of breath, but is caused by abnormal vocal cord movement.
  • Gastroesophageal reflux disease (GERD): Can trigger respiratory symptoms that mimic asthma, such as coughing and wheezing, especially at night.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pulmonary embolism: Although less common, pulmonary embolism can present with sudden onset of shortness of breath and wheezing, making it a critical diagnosis not to miss due to its high mortality rate if untreated.
  • Cardiac conditions (e.g., heart failure): Can cause wheezing and shortness of breath, and missing these diagnoses can have severe consequences.
  • Pneumonia: Certain types of pneumonia can present with symptoms similar to asthma, and missing this diagnosis can lead to severe outcomes if not treated promptly.
• Rare diagnoses
  • Cystic fibrosis: A genetic disorder that can cause chronic respiratory symptoms similar to asthma, but is much rarer and typically diagnosed at a younger age.
  • Bronchiolitis obliterans: A rare condition characterized by inflammation and obstruction of the small airways, which can mimic asthma symptoms.
  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): A rare autoimmune disorder that can cause asthma-like symptoms, along with other systemic manifestations.