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Differential diagnosis of common respiratory conditions (Guidelines)

Diagnosis  Suggestive features 


(Chronic Obstructive Pulmonary Disease)

Onset in mid-life
  • Symptoms slowly progressive
  • History of tobacco smoking or exposure to other types of smoke
  • Physical activity
  • Flu vaccination
  • Pneumococcal vaccination


Onset early in life (often childhood)
  • Symptoms vary widely from day to day
  • Symptoms worse at night/early morning
  • Allergy, rhinitis, and/or eczema also present
  • Family history of asthma
  • Obesity coexistence
Congestive heart failure
  • Chest X-ray shows dilated heart, pulmonary oedema.
  • Pulmonary function tests indicate volume restriction, not airflow/imitation
  • Large volumes of purulent sputum
  • Commonly associated with bacterial infection
    Chest X-ray/CT shows bronchial dilation, bronchial wall thickening.
Tuberculosis Onset all ages
  • Chest X-ray shows lung infiltrate
  • Microbiological confirmation
  • High local prevalence of tuberculosis
Obliterative bronchiolitis Onset at younger age, non-smokers
  • May have history of rheumatoid arthritis or acute fume exposure
  • Seen after lung or bone marrow transplantation
  • CT on expiration shows hypodense areas
Diffuse panbronchiolitis
  • Predominantly seen in patients of Asian descent
  • Most patients are male and non-smokers
  • Almost all chronic sinusitis
  • Chest/X-ray and high-resolution computed tomography show diffuse small centrilobular nodular opacities and hyperinflation
These features tend to be characteristic of the respective diseases, but are not mandatory. For example, a person who has never smoked may develop COPD (especially in the developing world where other risk factors may be more important than cigarette smoking); asthma may develop in adult and even in elderly patients.

Last reviewed: 03/12/2021

Next review date: 03/12/2024

Author(s): Advanced Practice Respiratory Nurse.

Version: 1

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Michelle Duffy.

Document Id: TAM364