Differential Diagnosis of COPD

COPD

Middle age

Sometimes lung hyperinflation, bullae, increased retrosternal air space, and/or bronchial wall thickening (seen on chest imaging); however, imaging usually is not helpful diagnostically and is done mainly to exclude other disorders

Slowly progressive symptoms

History of smoking or exposure to tobacco or other types of smoke

Asthma

Early in life (often during childhood)

Usually normal or possibly hyperinflation

Symptoms vary widely from day to day

Variable airflow obstruction

Symptoms often worse at night or early morning

History of allergies, rhinitis, or eczema

Often family history of asthma

Bronchiectasis

All ages, but most often in older or middle aged adults

Bronchial dilation and bronchial wall thickening (seen on chest radiograph or chest CT)

Often large amounts of purulent sputum

Often history of chronic recurrent bacterial infection

Diffuse panbronchiolitis

Usually between ages 10 and 60 years (mean age of 40)

Diffuse small centrilobular nodular opacities and hyperinflation seen on chest radiograph and high-resolution CT

Mostly males who do not smoke

Almost all have chronic sinusitis

Predominately in those of Asian descent

Heart failure

All ages, but most often in older or middle age

Enlarged heart, pleural effusion, fluid in major fissure, sometimes pulmonary edema (seen on chest radiograph)

Volume restriction without airflow limitation (detected by pulmonary function tests)

Obliterative bronchiolitis

Onset at younger age

Peripheral hypodense areas (seen on chest CT during expiration)

History of lung or bone marrow transplantation

Tuberculosis (TB)

All ages

Lung infiltrates seen on chest radiograph

Confirmed by microbiologic testing

Usually in areas with high prevalence of TB