Summary of Differential Diagnoses for COPD and Exacerbations
As a follow up to the recent post on Diagnosing COPD, in this post we look at the differential diagnoses for COPD. Let’s start with a simple definition.
A differential diagnosis is a list of possible conditions that share the same symptoms.
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Differential Diagnoses for COPD
The COPD GOLD 2024 Slideset contains a useful summary of the main differential diagnoses for COPD. These are shown below.
Differential Diagnoses for Acute Exacerbations of COPD
In addition to this, we have looked at several NICE guidelines and come up with the following (non-exhaustive) table that looks at the differential diagnoses for acute exacerbations of COPD. While it doesn’t cover everything, it forms a good starting point for anyone conducting consultations or evaluating requests for rescue packs. As usual, it should be used in the context of good clinical judgment and ownership of decision-making.
| Symptom | COPD exacerbation | Lung Cancer | Myocardial Infarction | Heart Failure | Pulmonary Embolism | Asthma exacerbation | Bronchiectasis exacerbation | Interstitial Lung Disease | Anaemia | Cystic Fibrosis | TB/ Non-TB Mycobacteria | Diabetic Ketoacidosis | Pericarditis/ cardiac tamponade | Arrhythmias | ACS | GORD | Lung/ lobar collapse |
| Increased Breathlessness | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | ||
| Unexplained new onset cough at age >/= 40 | Yes | ||||||||||||||||
| Increased cough | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | ||||
| Change in sputum colour/ purulence | Yes | Yes | Yes | Yes | Yes | ||||||||||||
| Change in sputum volume | Yes | Yes | Yes | Yes | |||||||||||||
| Change in suptum viscosity | Yes | Yes | Yes | ||||||||||||||
| Fatigue | Yes | Yes | Yes | Yes | |||||||||||||
| Palpitations | Yes | Yes | |||||||||||||||
| Onset within previous 5 days | Yes | ||||||||||||||||
| Chest pain | Yes | Yes | Yes | ||||||||||||||
| Chest tightness | Yes | ||||||||||||||||
| Wheeze | Yes | Yes | |||||||||||||||
| Tachypnoea | Yes | ||||||||||||||||
| Nausea and vomiting | Yes | ||||||||||||||||
| Sweating | Yes |
The references for the second table above are provided below, in case you wish to look at this further and update your copy of the table above.
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References
| NICE, “Chest pain: What are the signs and symptoms of cardiac causes of chest pain?,” National Institute for Health and Care Excellence, August 2022. [Online]. Available: https://cks.nice.org.uk/topics/chest-pain/diagnosis/cardiac-causes/#:~:text=Neurological%20deficits%20may%20be%20present%20%28such%20as%20hemiplegia%29.,Neurological%20deficits%20may%20be%20present%20%28such%20as%20hemiplegia%29.. [Accessed 17 May 2023]. | ||||||||||||||
| NICE, “Pulmonary Embolism: When should I suspect pulmonary embolism?,” National Institute for Health and Care Excellence, March 2022. [Online]. Available: https://cks.nice.org.uk/topics/pulmonary-embolism/diagnosis/when-to-suspect/. [Accessed 17 May 2023]. | ||||||||||||||
| NICE, “Asthma: What are the differential diagnoses of Asthma?,” National Institute for Health and Care Excellence, April 2022. [Online]. Available: https://cks.nice.org.uk/topics/asthma/diagnosis/differential-diagnosis/. [Accessed 17 May 2023]. | ||||||||||||||
| GP Notebook, “Interstitial Lung Disease,” Oxbridge Solutions Limited, September 2021. [Online]. Available: https://gpnotebook.com/en-gb/simplepage.cfm?&ID=1476788304. [Accessed 17 May 2023]. | ||||||||||||||
| NICE, “Breathlessness: Pulmonary Causes of Breathlessness,” National Institute for Health and Care Excellence, February 2022. [Online]. Available: https://cks.nice.org.uk/topics/breathlessness/diagnosis/pulmonary-causes/. [Accessed 17 May 2023]. | ||||||||||||||
| NICE, “Anaemia – Iron deficiency: What are the signs and symptoms of iron deficiency anaemia?,” National Institute for Health and Care Excellence, November 2021. [Online]. Available: https://cks.nice.org.uk/topics/anaemia-iron-deficiency/diagnosis/signs-symptoms/. [Accessed 17 May 2023]. | ||||||||||||||
| NICE, “NICE Guideline [NG78]: Cystic fibrosis: diagnosis and management,” National Institute for Health and Care Excellence, 25 October 2017. [Online]. Available: https://www.nice.org.uk/guidance/ng78/chapter/Recommendations#diagnosis-of-cystic-fibrosis. [Accessed 17 May 2023]. | ||||||||||||||
| Tuberculosis, “Tuberculosis,” National Institute for Health and Care Excellence, January 2019. [Online]. Available: https://cks.nice.org.uk/topics/tuberculosis/. [Accessed 17 May 2023]. | ||||||||||||||
| NICE, “When should I suspect diabetic ketoacidosis in a person with type 1 diabetes?,” National Institute for Health and Care Excellence, March 2023. [Online]. Available: https://cks.nice.org.uk/topics/diabetes-type-1/diagnosis/when-to-suspect-diabetic-ketoacidosis/. [Accessed 17 May 2023]. | ||||||||||||||
| NICE, “Scenario: Acute exacerbation of chronic obstructive pulmonary disease,” National Institute for Health and Care Excellence, November 2021. [Online]. Available: https://cks.nice.org.uk/topics/chronic-obstructive-pulmonary-disease/management/acute-exacerbation/. [Accessed 17 May 2023]. |
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