Differential Diagnosis
- Single most likely diagnosis
- Asthma: The patient's symptoms of wheezing, productive cough, and shortness of breath, particularly at night and with exercise, are classic for asthma. The fact that his symptoms worsened after initial improvement with antibiotics and steroids suggests a chronic condition like asthma.
- Other Likely diagnoses
- Chronic Obstructive Pulmonary Disease (COPD): Although the patient is a non-smoker, COPD can still occur in non-smokers, especially with a history of recurrent respiratory infections. The patient's symptoms of wheezing, cough, and shortness of breath are consistent with COPD.
- Allergic Rhinitis: The patient's symptoms of nasal congestion, postnasal drainage, and rhinorrhea, despite taking cetirizine, suggest allergic rhinitis. However, the presence of wheezing and shortness of breath suggests that there may be a more complex condition at play.
- GERD-induced asthma or cough: The patient's symptoms of worsening cough and shortness of breath at night, particularly when lying down, could be related to gastroesophageal reflux disease (GERD).
- 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, it is a potentially life-threatening condition that must be considered, especially in older adults with risk factors such as immobility and stress.
- Pneumonia: The patient's history of recent antibiotic treatment and subsequent worsening of symptoms raises the possibility of pneumonia, particularly if the initial treatment was ineffective or if the patient has developed a new infection.
- Cardiac disease (e.g., heart failure): The patient's symptoms of shortness of breath, particularly when lying down, could be related to cardiac disease, such as heart failure.
- Rare diagnoses
- Churg-Strauss syndrome: This rare condition is characterized by asthma, eosinophilia, and vasculitis. Although it is unlikely, it could be considered if the patient's symptoms do not respond to standard treatments and if there are other systemic symptoms present.
- Bronchiectasis: This condition is characterized by chronic bronchial dilation and infection. Although it is rare, it could be considered if the patient's symptoms do not respond to standard treatments and if there are other symptoms such as hemoptysis or clubbing.