What is the cause of nocturnal wheezing, cough exacerbation when in a supine position, production of some phlegm (sputum) when coughing, and mild headaches?

Differential Diagnosis for Wheezing, Cough, and Mild Headaches

Single Most Likely Diagnosis

• Asthma: This condition is characterized by recurrent episodes of wheezing, coughing, and shortness of breath, often worse at night and when lying down. The presence of wheezing and cough with some phlegm production aligns closely with asthma symptoms.

Other Likely Diagnoses

• Chronic Obstructive Pulmonary Disease (COPD): COPD can cause similar symptoms, including wheezing, cough, and production of phlegm, especially in smokers or those with a history of exposure to lung irritants.
• Gastroesophageal Reflux Disease (GERD): GERD can lead to nighttime cough and wheezing due to acid reflux irritating the airways, especially when lying down.
• Allergic Rhinitis: Postnasal drip from allergic rhinitis can trigger coughing and wheezing, particularly at night, and may be accompanied by mild headaches due to sinus pressure.

Do Not Miss Diagnoses

• Pneumonia: Although less likely, pneumonia is a critical diagnosis not to miss, as it can present with cough, wheezing, and worsening symptoms when lying down. The presence of mild headaches could indicate a systemic infection.
• Pulmonary Embolism: This is a life-threatening condition that can cause sudden onset of wheezing, cough, and shortness of breath, sometimes accompanied by chest pain and headaches.
• Heart Failure: Congestive heart failure can lead to wheezing (cardiac asthma) and cough due to pulmonary edema, especially when lying down (orthopnea).

Rare Diagnoses

• Cystic Fibrosis: A genetic disorder leading to persistent lung infections and progressive lung damage, characterized by chronic cough, wheezing, and production of thick, sticky phlegm.
• Bronchiectasis: A condition where parts of the airways are permanently enlarged, leading to chronic cough, wheezing, and production of large amounts of phlegm.
• Vocal Cord Dysfunction: A condition where the vocal cords do not function normally, leading to wheezing and coughing, often mimicking asthma but without the typical response to asthma treatments.