Differential Diagnosis

The patient presents with worsening respiratory symptoms, green sputum production, persistent cough with wheeze, and episodes of facial/chest flushing. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Chronic bronchitis exacerbation: The patient's history of COPD, bronchiectasis, and symptoms of worsening respiratory function, cough, and sputum production are consistent with a chronic bronchitis exacerbation. The recent completion of a course of azithromycin and subsequent deterioration also support this diagnosis.
• Other Likely diagnoses
  • Bronchiectasis exacerbation: The patient's history of bronchiectasis and symptoms of worsening respiratory function, cough, and sputum production are consistent with a bronchiectasis exacerbation.
  • Pneumonia: The patient's symptoms of cough, sputum production, and fine crackles heard at the right lower lobe are consistent with pneumonia.
  • Asthma: The patient's symptoms of wheeze and cough are consistent with asthma, although the lack of a clear history of asthma and the presence of other respiratory conditions make this diagnosis less likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pulmonary embolism: Although the patient's symptoms do not strongly suggest pulmonary embolism, the history of previous heart attack and current respiratory symptoms make it essential to consider this diagnosis.
  • Lung cancer: The patient's history of smoking and current respiratory symptoms make it essential to consider lung cancer, especially if the symptoms persist or worsen despite treatment.
  • Cardiac failure: The patient's history of previous heart attack and current respiratory symptoms make it essential to consider cardiac failure, especially if the symptoms worsen or if there are signs of fluid overload.
• Rare diagnoses
  • Cystic fibrosis: Although the patient's age and lack of a clear history of cystic fibrosis make this diagnosis unlikely, it is essential to consider it in the differential diagnosis, especially if the patient's symptoms persist or worsen despite treatment.
  • Alpha-1 antitrypsin deficiency: The patient's history of COPD and bronchiectasis make it essential to consider alpha-1 antitrypsin deficiency, especially if the patient's symptoms persist or worsen despite treatment.
  • Wegener's granulomatosis: The patient's symptoms of respiratory dysfunction, facial erythema, and episodes of flushing make it essential to consider Wegener's granulomatosis, although this diagnosis is rare and would require further investigation to confirm.