Differential diagnosis

None of the symptoms present in COPD are specific for the disease.

Several other conditions may have similar symptoms, signs and spirometry results:

• asthma
  • variable airflow obstruction
  • onset occurs in children
  • symptoms vary widely from day to day
  • symptoms worse at night/early morning
  • allergy, rhinitis, and/or eczema also present
  • family history of asthma
  • obesity coexistence
• bronchiectasis
  • may occur due to defects of mucociliary clearance, as in cystic fibrosis, Kartagener's syndrome and congenital immunodeficiency. These conditions have become more significant causes of bronchiectasis as childhood suppurative disease becomes rarer
  • more common in females
  • approximately 60% of bronchiectasis diagnoses are made in people aged over 70 years
• congestive cardiac failure
  • chest X-ray shows bronchial dilation
  • pulmonary function tests indicate volume restriction, not airflow limitation
• carcinoma of the bronchus
  • vast majority related to exposure to cigarette smoking (86%)
  • peak incidence of bronchial carcinoma is in the sixth decade in males and in the seventh decade in females
• tuberculosis
  • onset all ages
  • chest X-ray shows lung infiltrate
  • microbiological confirmation
  • high local prevalence of tuberculosis
• obliterative bronchiolitis
  • onset at younger age, non-smokers
  • may have history of rheumatoid arthritis or acute fume exposure
  • seen after lung or bone marrow transplantation
  • CT on expiration shows hypodense areas
• bronchopulmonary dysplasia
• diffuse panbronchilitis (1,2)
  • predominantly seen in patients of Asian descent
  • most patients are male and non-smokers
  • almost all have chronic sinusitis
  • chest X-ray and high-resolution computed tomography show diffuse small centrilobular nodular opacities and hyperinflation

It is important to remember that elderly patients are more likely to have a number of concomitant problems (1).

Reference:

1. National Institute for Health and Clinical Excellence (NICE) 2019. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care.
2. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease