Differential Diagnosis for a 76-year-old with Cough, Fatigue, and Shortness of Breath
- Single most likely diagnosis:
- Acute exacerbation of COPD (AECOPD): This is the most likely diagnosis given the patient's history of COPD, increased use of albuterol inhaler, and symptoms of cough, fatigue, and shortness of breath. The production of nickel-sized phlegm also supports this diagnosis, as it indicates an increase in bronchial secretions, a common feature of AECOPD.
- Other Likely diagnoses:
- Community-acquired pneumonia (CAP): The patient's symptoms of cough, fatigue, and shortness of breath, along with the production of phlegm, could also suggest CAP, especially in an elderly individual with a history of COPD.
- Bronchitis: Acute bronchitis could be considered, given the cough and increased phlegm production, although the presence of fatigue and shortness of breath might lean more towards AECOPD or CAP.
- Do Not Miss diagnoses:
- Pulmonary embolism (PE): Although less likely, PE is a critical diagnosis that must be considered, especially in an elderly patient with shortness of breath and fatigue. The presence of COPD increases the risk of PE.
- Cardiac causes (e.g., heart failure, myocardial infarction): These conditions can present with similar symptoms and are important to rule out, especially in an elderly patient with potential comorbidities.
- Rare diagnoses:
- Lung cancer: Although less likely given the acute presentation, lung cancer could be considered in the differential, especially if the patient has a history of smoking or other risk factors.
- Tuberculosis (TB): TB is less common but should be considered, especially if the patient has been exposed to TB or has risk factors such as immunosuppression. However, the acute presentation and lack of systemic symptoms (e.g., fever, night sweats, weight loss) make this less likely.