Differential diagnosis

The differential diagnosis of asthma varies with age:

• 6-11 years
  • chronic upper airway cough syndrome -sneezing, itching, blocked nose, throat-clearing
  • inhaled foreign body - sudden onset of symptoms, unilateral wheeze
  • bronchiectasis - recurrent infections, productive cough
  • primary ciliary dyskinesia - recurrent infections, productive cough, sinusitis
  • congenital heart disease - cardiac murmurs
  • bronchopulmonary dysplasia - pre-term delivery, symptoms since birth
  • cystic fibrosis - excessive cough and mucus production, gastrointestinal symptoms
• 12-39 years
  • chronic upper airway cough syndrome - sneezing, itching, blocked nose, throat-clearing
  • vocal cord dysfunction - dyspnea, inspiratory wheezing (stridor)
  • hyperventilation, dysfunctional breathing - dizziness, paresthesia, sighing
  • bronchiectasis - productive cough, recurrent infections
  • cystic fibrosis - excessive cough and mucus production
  • congenital heart disease - cardiac murmurs
  • alpha1-antitrypsin deficiency - shortness of breath, family history of early emphysema
  • inhaled foreign body - sudden onset of symptoms
• 40+ years
  • vocal cord dysfunction - dyspnea, inspiratory wheezing (stridor)
  • hyperventilation, dysfunctional breathing - dizziness, paresthesia, sighing
  • COPD - cough, sputum, dyspnea on exertion, smoking or noxious exposure
  • bronchiectasis - productive cough, recurrent infections
  • cardiac failure - dyspnea with exertion, nocturnal symptoms
  • medication-related cough - treatment with angiotensin converting enzyme (ACE) inhibitor
  • parenchymal lung disease - dyspnea with exertion, non-productive cough, finger clubbing
  • pulmonary embolism - sudden onset of dyspnea, chest pain
  • central airway obstruction - dyspnea, unresponsive to bronchodilators
• All ages
  • Tuberculosis - chronic cough, hemoptysis, dyspnea; and/or fatigue, fever, (night) sweats, anorexia, weight loss
  • Pertussis - prolonged paroxysms of coughing, sometimes stridor

Reference:

1. Global Initiative For Asthma (GINA) 2023. Global strategy for asthma management and prevention