Version June 2024
| Diagnosis | Clinical features | Testing |
| Alpha-1 antitrypsin deficiency | Dyspnea Family history emphysema | Alpha-1 antitrypsin: below 50 to 80 mg/dL (11 micromol/L) Genetic confirmation by isoelectric focusing or DNA PCR |
| Bronchiectasis | Daily sputum production Cough refractory to bronchodilators Sometimes end-inspiratory squeak May have rhinosinusitis | HRCT thorax: bronchiectasis |
| Bronchiolitis | History of respiratory infection, inhalational injury, CTD, or lung transplant Crackles and inspiratory squeaks on exam | PFTs: DLCO and oxygen saturation are reduced HRCT thorax: interstitial opacities in a mosaic pattern, inspiratory and expiratory views may show focal air trapping |
| Cardiac disease* | Crackles or wheezes | B type natriuretic peptide: elevated Chest xray: increased interstitial opacities, ±cardiomegaly Echocardiogram: reduced ejection fraction |
| Central airway obstruction | Dyspnea on exertion Sometimes monophonic wheeze or stridor | PFTs: flattening of flow volume loop HRCT with 3-D reconstruction: narrowed airway Direct visualization: airway obstruction |
| Chronic eosinophilic pneumonitis | Asthma predates or develops in over 50 percent of patients Fever, weight loss and night sweats are common | Peripheral blood: ±eosinophilia Chest xray: bilateral peripheral opacities BAL: eosinophilia >40 percent |
| COPD* | Smoking history | PFTs: irreversible airflow obstruction and sometimes low DLCO |
| Hypersensitivity pneumonitis | Exposure to an inciting agent Abrupt onset fever, chills Dyspnea without wheezing | PFTs: restrictive or mixed obstructive/restrictive pattern Chest xray: fleeting pulmonary infiltrates HRCT thorax: ground glass opacities and parenchymal micronodules BAL: lymphocytosis Lung biopsy: poorly formed granulomata |
| Obstructive sleep apnea* | Daytime hypersomnolence Nocturnal choking Snoring | Polysomnogram: elevated respiratory disturbance index |
| Sarcoidosis* (endobronchial) | Nonproductive cough Dyspnea Cutaneous stigmata of sarcoidosis May have nasal or sinus sarcoid | Chest xray: Hilar adenopathy with or without interstitial opacities PFTs: restriction and reduced DLCO Endobronchial biopsy: noncaseating granulomata |
| Strongyloidiasis, filariasis | Travel to endemic country | Peripheral blood: eosinophilia IgG antibodies to strongyloides or filaria: positive |
| Inducible laryngeal obstruction (vocal cord dysfunction)* | Hoarseness/stridor (can be inspiratory and/or expiratory) Symptoms provoked by exercise | Flow volume loop: slowing on inspiration Direct laryngoscopy (possibly during exercise or methacholine challenge): abnormal cord motion |
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