From the Guidelines
The diagnosis for this 43-year-old female presenting with cough, shortness of breath, tachypnea, and wheezing for 3 days, with no history of asthma, is likely pneumonia, given the presence of suggestive symptoms and signs such as cough, dyspnea, tachypnea, and the absence of a runny nose, as suggested by the 2019 Chest guideline and expert panel report 1. The patient's symptoms, including cough, shortness of breath, tachypnea, and wheezing, are consistent with pneumonia, as outlined in the guideline, which suggests that these symptoms, along with others such as pleural pain, sweating/fevers/shivers, aches and pains, temperature 38C or greater, and new and localizing chest examination signs, are suggestive of pneumonia 1. Key points to consider in the diagnosis of pneumonia include:
- The presence of cough, dyspnea, and tachypnea, which are all suggestive of pneumonia 1
- The absence of a runny nose, which makes a diagnosis of a common cold less likely 1
- The presence of fever, which is a common symptom of pneumonia 1
- The use of C-reactive protein (CRP) to strengthen the diagnosis and exclusion of pneumonia, with a CRP of 30 mg/L or greater increasing the likelihood of pneumonia 1 Further investigation should include:
- Chest X-ray to confirm the diagnosis of pneumonia and rule out other pathology, as suggested by the guideline 1
- Measurement of CRP to strengthen the diagnosis and exclusion of pneumonia 1
- Consideration of pulmonary function testing after the acute episode resolves to assess for any underlying respiratory conditions 1 Management should include:
- Empiric antibiotics as per local and national guidelines, if pneumonia is suspected, as suggested by the guideline 1
- Supplemental oxygen to maintain oxygen saturation above 92%
- A systemic corticosteroid, such as prednisone, to reduce airway inflammation, if symptoms are severe
- Close follow-up within 1-2 weeks to reassess symptoms and consider maintenance therapy if symptoms persist.
From the Research
Diagnosis Considerations
- The patient's symptoms of cough, shortness of breath (SOB), tachypnea, and wheezing for 3 days could be indicative of several conditions, including COVID-19 pneumonia 2 or an asthma exacerbation 3, 4, 5.
- However, the patient has no history of asthma, which may suggest alternative diagnoses such as COVID-19 pneumonia 2 or other obstructive pulmonary disorders.
- A thorough patient history and physical examination, as well as diagnostic tests such as chest X-ray and nasopharyngeal PCR swab, are necessary to determine the underlying cause of the patient's symptoms.
Differential Diagnoses
- COVID-19 pneumonia: The patient's symptoms are consistent with COVID-19 pneumonia, particularly the presence of cough, SOB, and tachypnea 2.
- Asthma exacerbation: Although the patient has no history of asthma, it is possible that the patient is experiencing an asthma exacerbation, particularly given the presence of wheezing and SOB 3, 4, 5.
- Other obstructive pulmonary disorders: The patient's symptoms could also be indicative of other obstructive pulmonary disorders, such as chronic obstructive pulmonary disease (COPD) or healthcare-associated pneumonia (HCAP) 6.
Diagnostic Testing
- Chest X-ray: A chest X-ray may be useful in diagnosing COVID-19 pneumonia or other pulmonary disorders 2, 6.
- Nasopharyngeal PCR swab: A nasopharyngeal PCR swab may be useful in diagnosing COVID-19 2.
- Pulmonary function tests: Pulmonary function tests, such as spirometry, may be useful in diagnosing asthma or other obstructive pulmonary disorders 3, 4, 5.