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, >30 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