Table 3

Differential diagnosis of chronic obstructive pulmonary disease (COPD)

DiagnosisSuggestive features
COPDMid-life onset
Slowly progressing symptoms
Long history of smoking
AsthmaEarly onset
Varying symptoms
Symptoms during the night/early morning
Presence of allergy, rhinitis and/or eczema
A family history
Airflow limitation that is largely reversible
Congestive heart failureFine basilar crackles on auscultation
Dilated heart on chest radiography
Pulmonary oedema
Volume restriction not airflow limitation on pulmonary function tests
BronchiectasisLarge volume of purulent sputum
Commonly associated with bacterial infection
Coarse crackles/clubbing on auscultation
Bronchial dilation and bronchial wall thickening on chest radiography/CT
TuberculosisOnset at all ages
Lung infiltrate on chest radiography
Microbiological confirmation
High local prevalence of tuberculosis
Obliterative bronchiolitisYounger onset and in nonsmokers
History of rheumatoid arthritis/fume exposure
Hypodense areas on expiration on CT suggestive of bronchiolitis
Diffuse panbronchiolitisEffects mostly male nonsmokers
Almost all have chronic sinusitis
Diffuse small centrilobular nodular opacities and hyperinflation on chest radiography and HRCT
  • CT: computed tomography

  • HRCT: high resolution computed tomography