Bronchiectasis differential diagnosis

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Overview

The differential diagnosis for bronchiectasis is COPD, asthma, pneumonia, tuberculosis, chronic sinusitis, cough due to gastrointestinal reflux, upper airway cough syndrome, cancer of the lung, and inhaled foreign body.

Bronchiectasis Differential Diagnosis

• Chronic Obstructive Pulmonary Disease (COPD)

• Diminished breath sounds in COPD are not found in bronchiectasis
• Chest CT will be normal or show emphysema is patients with COPD

• Asthma

• Crackles found in bronchiectasis will not be found in asthma
• Airflow obstruction is reversible in asthma

• Pneumonia

• Patients with pneumonia will express symptoms for a short duration of 7-10 days, whereas patients with bronchiectasis express symptoms for years
• Patients with pneumonia have bronchial breath sounds on auscultation
• Consolidation is seen on chest x-ray and chest CT in patients with pneumonia

• Tuberculosis
• Chronic Sinusitis

• Crackles found in bronchiectasis will not be found in chronic sinusitis
• Chest x-ray and chest CT are normal in chronic sinusitis

• Cough due to gastrointestinal reflux
• Upper airway cough syndrome (postnasal drip)
• Cancer of the lung
• Inhaled foreign body

Features that may suggest bronchiectasis in a patient presenting with chronic respiratory symptoms

• Digital clubbing
• Lack of a significant smoking history if you suspect a patient has COPD
• History of recurrent and/or severe pneumonia or tuberculosis
• Presence of Aspergillus, atypical/nontuberculous mycobacteria, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae in the sputum
• If the childhood is associated with significant environmental and social disadvantage