Diagnosis | Clinical features | Testing |
Allergic bronchopulmonary aspergillosis | History of asthma or cystic fibrosis Cough productive of phlegm with "bronchial casts" | Eosinophilia IgE: >1000 IU/mL Skin test: positive for aspergillus Aspergillus IgG: 2 fold elevation HRCT: mucous plugging, proximal bronchiectasis |
Cardiac disease | Crackles or wheezes | B type natriuretic peptide: elevated Chest radiograph: increased interstitial opacities, ±cardiomegaly Echocardiogram |
Chronic eosinophilic pneumonia | Asthma predates or develops in over 50 percent of patients Fever, weight loss, and night sweats are common | Peripheral blood: ±eosinophilia Chest radiograph: bilateral peripheral opacities BAL: eosinophilia >40 pecent |
Eosinophilic granulomatosis polyangiitis (Churg Strauss) | Cutaneous, neurologic, or other evidence vasculitis Paranasal sinus disease | ANCA: positive in 50 percent of patients Eosinophilia: >10 percent Chest radiograph: patchy opacities Biopsy: granulomatous angiitis |
COPD | Smoking history | PFTs: irreversible airflow obstruction and sometimes low DLCO |
GERD | May complain of chest tightness/restriction or nocturnal choking | Response to empiric treatment with PPI pH probe monitoring: acid reflux Spirometry normal, methacholine negative* |
Obstructive sleep apnea | Daytime hypersomnolence Nocturnal choking Snoring | Polysomnogram: elevated apnea hypopnea index |
Tobacco smoke exposure | History | |
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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