Differential Diagnosis of COPD
Diagnosis | Onset | Imaging Results | Other Features |
|---|---|---|---|
COPD | Middle age | Sometimes lung hyperinflation, bullae, increased retrosternal air space, and/or bronchial wall thickening (seen on chest imaging); however, imaging is usually 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 |
Early in life (often during childhood) | Usually normal or possibly hyperinflation (eg, during an asthma exacerbation) | Symptoms vary widely from day to day Variable but reversible airflow obstruction Symptoms often worse at night or early morning History of allergies, rhinosinusitis, or eczema Often family history of asthma | |
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 years) | Diffuse small centrilobular nodular opacities and hyperinflation seen on chest radiograph and high-resolution CT | Mostly males who do not smoke Almost all patients have chronic sinusitis Predominately in individuals of Asian descent |
All ages, but most often in older or middle aged adults | Enlarged heart, pleural effusion, fluid in major lung 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 Inspiratory squeaks (ie, high-pitched, end-inspiratory wheezes) on auscultation |
All ages | Lung infiltrates and cavitation (typically on the upper lobes) seen on chest radiograph | Confirmed by microbiologic testing (eg, NAAT, AFB staining, mycobacterial culture) Usually in areas with high prevalence of TB | |
Data adapted from Global Initiative for Chronic Obstructive Lung Disease (GOLD): Diagnosis and assessment. Global Strategy for the Prevention, Diagnosis, and Management of COPD: 2026 report. | |||
AFB = acid-fast bacillus; NAAT = nucleic acid amplification test. | |||