Differential Diagnosis for 46-year-old Female with Respiratory Symptoms
- Single most likely diagnosis:
- Asthma exacerbation: The patient has a significant past medical history of asthma, and her symptoms of cough, chest tightness with coughing, shortness of breath with exertion, and wheezing, especially at night, are classic for an asthma exacerbation. The fact that she hasn't used her albuterol inhaler because she was out suggests that her symptoms could be related to uncontrolled asthma.
- Other Likely diagnoses:
- Acute bronchitis: Given the progression of symptoms from sore throat and headache to rhinorrhea and cough, acute bronchitis is a possible diagnosis. The presence of cough and chest tightness also supports this diagnosis.
- Chronic obstructive pulmonary disease (COPD) exacerbation: Although the patient's primary diagnosis is asthma, she could also have COPD, especially given her age and symptoms of wheezing and shortness of breath.
- Upper respiratory infection: The initial symptoms of sore throat, headache, and rhinorrhea suggest an upper respiratory infection, which could have triggered or contributed to her current respiratory symptoms.
- Do Not Miss diagnoses:
- Pneumonia: Although the patient is afebrile, pneumonia is a critical diagnosis that must be considered, especially if there's any suspicion of infection. It's essential to evaluate for pneumonia to avoid missing a potentially life-threatening condition.
- Pulmonary embolism: This is a critical diagnosis that must be considered, especially in patients with shortness of breath and chest tightness. Although the patient's symptoms are more suggestive of asthma or bronchitis, pulmonary embolism can present with similar symptoms and is a life-threatening condition if missed.
- Cardiac causes (e.g., heart failure, acute coronary syndrome): Given the patient's history of hypertension and elevated blood pressure in the clinic, cardiac causes must be considered, especially if there's any suspicion of chest pain or cardiac symptoms.
- Rare diagnoses:
- Interstitial lung disease: This is a less likely diagnosis but could be considered if the patient's symptoms persist or worsen despite treatment for asthma or bronchitis.
- Cystic fibrosis: Although rare in adults, cystic fibrosis could be considered if the patient has recurrent respiratory infections or persistent symptoms despite treatment.
- Allergic bronchopulmonary aspergillosis: This is a rare condition that occurs in patients with asthma and could be considered if the patient has persistent symptoms or worsening respiratory function despite treatment for asthma.