Diagnosis | Suggestive features* |
COPD | Onset in mid-life; onset in early adulthood should prompt suspicion for alpha-1 antitrypsin deficiency |
Symptoms slowly progressive | |
Long smoking history, although can occur in nonsmokers | |
Dyspnea during exercise | |
Largely irreversible airflow limitation | |
Asthma | Onset early in life (often childhood) |
Symptoms vary from day to day | |
Symptoms at night/early morning | |
Allergy, rhinitis, and/or eczema also present | |
Family history of asthma | |
Largely reversible airflow limitation | |
Central airway obstruction (eg, bronchogenic or metastatic cancer, lymphadenopathy, scarring from endotracheal tube) | Monophonic wheeze or stridor |
Variable inspiratory or fixed slowing on flow volume loop | |
Chest radiograph often normal | |
Airway narrowing on three dimensional reconstruction of HRCT scan | |
Heart failure | Fine basilar crackles on auscultation |
Chest radiograph shows dilated heart, pulmonary edema | |
Pulmonary function tests typically indicate volume restriction, but airflow limitation can sometimes be seen | |
Bronchiectasis | Large volumes of purulent sputum |
Commonly associated with recurrent or persistent bacterial infection | |
Coarse crackles on auscultation, clubbing of digits | |
Chest radiograph/HRCT shows bronchial dilation, bronchial wall thickening | |
Tuberculosis | Onset all ages |
Chest radiograph shows upper lung zone scarring and/or calcified granulomata | |
Positive PPD or IGRA | |
High local prevalence of tuberculosis | |
Obliterative bronchiolitis | Onset in younger age, nonsmokers |
May have history of rheumatoid arthritis or fume exposure | |
HRCT on expiration shows hypodense areas, mosaic pattern | |
Diffuse panbronchiolitis | Most patients are male and nonsmokers |
Highest prevalence in East Asia | |
Almost all have chronic sinusitis | |
Chest radiograph and HRCT show diffuse small centrilobular nodular opacities and hyperinflation |
HRCT: high-resolution computed tomography; PPD: purified protein derivative; IGRA: interferon gamma release assay.
* These features tend to be characteristic of the respective diseases, but do not occur in every case. For example, a person who has never smoked may develop COPD (especially in the developing world, where other risk factors may be more important than cigarette smoking); asthma may develop in adult and even elderly patients.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟