鉴别诊断
Asthma
征象/症状
Onset of asthma is usually in early life. A personal or family history of allergy, rhinitis, and eczema is often present. There is daily variability in symptoms, and patients have overt wheezing that usually rapidly responds to bronchodilators. Cough variant asthma mimics many features of COPD.
辅助检查
Spirometry shows reversibility with bronchodilators. Pulmonary function tests show reversibility with bronchodilators and no decrease in diffusing capacity of the lung for carbon monoxide (DLCO). Sputum or blood eosinophilia is suggestive of asthma, although may also be present in COPD.
Congestive heart failure
征象/症状
Usually a history of cardiovascular diseases is present. Patients report symptoms of orthopnea, and fine bibasilar inspiratory crackles may be heard on auscultation.
辅助检查
B-type natriuretic peptide levels are usually elevated, and chest x-ray reveals increased pulmonary vascular congestion. Transthoracic echocardiogram establishes the structure and function of the left ventricle.
Bronchiectasis
征象/症状
There may be a history of recurrent infection in childhood. Large volume of purulent sputum is usually present. Coarse crackles may be heard on auscultation. History of pertussis or tuberculosis is a clue to diagnosis.
辅助检查
Chest CT reveals bronchial dilation and bronchial wall thickening.
Tuberculosis
征象/症状
A history of fever, night sweats, weight loss, and chronic productive cough is usually present. Tuberculosis is more common in people living in or originating from endemic areas.
辅助检查
The diagnosis requires microbiologic confirmation. Infiltrates, fibrosis, or granuloma seen on chest x-ray or chest CT may suggest tuberculosis. Patients usually have positive skin test for tuberculosis.
Bronchiolitis
征象/症状
Bronchiolitis may affect patients at younger ages. The patient may have a history of connective tissue disorders, especially rheumatoid arthritis, or fume exposure. Some cases are postinfectious.
辅助检查
Pulmonary function tests in bronchiolitis can present with obstructive, restrictive, or mixed pattern. Chest x-ray shows hyperinflation. High-resolution chest CT may show diffuse, small, centrilobular nodular opacities, but is rarely done in children due to radiation risk.
Upper airway dysfunction
征象/症状
Can affect patients of any age. History of prior trauma or intubation is very helpful. Lung examination is usually normal, but signs of upper airway restriction, such as wheezing and stridor, may be present. Patients may have voice hoarseness if vocal cords are involved.
辅助检查
The flow-volume curve in pulmonary function testing may reveal a characteristic expiratory or inspiratory plateau, or both. Diagnosis is confirmed by direct visualization of the affected airway by endoscopy.
Chronic rhinosinusitis/postnasal drip
征象/症状
Chronic rhinosinusitis is a very common cause of chronic cough. Patients may complain of sinus pressure, rhinorrhea, nonproductive cough, and/or headache.
辅助检查
Nasal endoscopy, CT of sinuses, and/or empiric trial of antihistamines are commonly utilized to aid in diagnosis.
Gastroesophageal reflux disease (GERD)
征象/症状
Patients with GERD often have dyspepsia and frequent belching, and can have a chronic cough that worsens at night when supine.
辅助检查
Diagnosis is usually based on response to empiric therapy with proton-pump inhibitors.
ACE inhibitor-induced chronic cough
征象/症状
ACE inhibitors can cause chronic cough; however, the cough is usually nonproductive.
辅助检查
Diagnosis is usually based on improvement of symptoms after empiric cessation of ACE inhibitor.
Lung cancer
征象/症状
Patients may have weight loss, night sweats, hemoptysis, and/or chest or back pain.
People with COPD are also at increased risk of lung cancer.
辅助检查
Radiography is important in the assessment for lung cancer. Bronchoscopy may be necessary to evaluate for endobronchial cancer if suspicion is high.
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