Alternative diagnoses in adults

This content is from the BTS/SIGN British guideline on the management of asthma (SIGN 158), 2019.

Clinical clue	Possible diagnosis
Without airflow obstruction
Predominant cough without lung function abnormalities	Chronic cough syndromes; pertussis
Prominent dizziness, light headedness, peripheral tingling	Dysfunctional breathing
Recurrent severe ‘asthma attacks’ without objective confirmatory evidence	Vocal chord dysfunction
Predominant nasal symptoms without lung function abnormalities	Rhinitis
Postural and food-related symptoms, predominant cough	Gastro-oesophageal reflux
Orthopnoea, paroxysmal nocturnal dyspnoea, peripheral oedema, pre-existing cardiac disease	Cardiac failure
Crackles in auscultation	Pulmonary fibrosis
With airflow obstruction
Significant smoking history (ie, >20 pack-years), age of onset >35 years	COPD
Chronic productive cough in the absence of wheeze or breathlessness	Bronchiectasis*; inhaled foreign body*; obliterative bronchiolitis; large airway stenosis
New onset in smoker, systemic symptoms, weight loss, haemoptysis	Lung cancer*; sarcoidosis*

*may also be associated with non-obstructive spirometry