Features and rules for differential diagnosis in bronchial asthma

In order to begin effective treatment of a disease, it is important to first make a correct diagnosis. And first of all, it is required to exclude diseases that have the same symptoms as bronchial asthma.

It is for this that differential diagnostics was developed and successfully applied. Confirmation of the diagnosis in bronchial asthma is an important stage preceding the treatment of the disease.

Bronchial asthma

Bronchial asthma is a chronic non-infectious disease. The inflammatory process in the bronchi causes an increased secretion of a thick, difficult to excrete secretion. In addition, edema of the bronchial mucosa is possible.

The patient has difficulty breathing, he has a dry cough, and may develop shortness of breath. Breathing becomes sibilant, exhalation is much longer than inhalation. An attack of bronchial asthma is accompanied by suffocation.  

Differential diagnosis in bronchial asthma allows you to exclude diseases that manifest similar symptoms, but require a completely different treatment.

The need for differential diagnosis in bronchial asthma

Bronchial asthma in the early stages has mild symptoms. Seizures are rare. Shortness of breath, if it appears, then only after exercise. 

During this period, it can be easily confused with respiratory diseases that cause similar symptoms.

The patient most often does not go to the doctor, preferring to cope with the malaise on his own.

However, asthma requires a completely different treatment than infectious diseases. Since most often attacks develop against the background of allergic reactions, first of all it is necessary to deal with this problem.

In order to accurately determine the disease and confirm or deny the diagnosis of bronchial asthma, differential diagnosis is required.

Only then can the doctor prescribe the correct treatment and select effective drugs.

What is the essence of differential diagnosis

Bronchial asthma is a disease that is difficult to diagnose. To confirm or refute the diagnosis, the doctor needs to carry out a differential diagnosis. It consists of the following steps:

  1. Collection and systematization of patient complaints.
  2. Examination of the patient.
  3. Finding out information about the presence of shortness of breath, the conditions for its appearance.
  4. Study of the patient’s history, identification of cases of allergic reactions.
  5. Conducting clinical studies of blood and urine, analysis of their results.
  6. Respiratory function assessment. For this, spirography and other methods are used.

Differential diagnosis requires a comprehensive examination. Only based on all the collected data, it can be argued that the patient suffers from bronchial asthma.

Differential diagnosis of bronchial asthma

Since bronchial asthma is very similar in its symptoms to some other diseases, it is important to conduct a number of studies. Based on the data obtained, a differential diagnosis can be made.

The symptoms of bronchial asthma are similar to the manifestations of bronchitis, cardiac asthma and other pathologies.   

In addition, a state of asphyxiation, for example, can cause a foreign body to block the airway.

Features of bronchial asthma

In order to make a correct diagnosis, it is important to consider the entire set of symptoms. The patient should have symptoms characteristic of AD. These include:

  • dry cough attacks;
  • shortness of breath, appearing even with little physical activity;
  • a state of suffocation, which can be stopped only with the help of bronchial dilating drugs.

All these symptoms cause severe discomfort to the patient and force him to seek medical help.

To make a diagnosis, the doctor uses differential diagnostic methods. At the same time, he first of all pays attention to the symptoms that are always associated with bronchial asthma.

Pallor of the skin, an increase in the heart rate, a change in the rhythm of breathing – all this is referred to as typical symptoms of asthma in adults and children. Very often, on auscultation, the doctor may hear wheezing (wheezing, heard on both sides of the chest).

However, it is important to remember that other diseases that are not associated with a chronic inflammatory process in the bronchi can give similar symptoms. Of the most common pathologies, it should be noted:

  • cardiac asthma;
  • COPD;
  • chronic nonspecific lung disease;
  • neoplasms in the lungs.

That is why differential diagnostics is an important tool for making a correct diagnosis.

Difference from chronic bronchitis

Bronchial asthma is very similar in symptoms to chronic bronchitis. But with these pathologies, completely different treatment regimens are used.

That is why it is very important to correctly differentiate the disease and not only establish its root cause, but also determine the ways of treatment.

Differential diagnosis reveals a number of fundamental differences between bronchitis and bronchial asthma:

  1. The appearance of shortness of breath in bronchitis is not associated with the presence of an allergen. There is no paroxysmal manifestations.
  2. Dry wheezing appears in the first phase of breathing and is audible even from a distance.
  3. With bronchitis, there is no reversibility of symptoms.

For the final diagnosis, a number of laboratory tests should be carried out. The doctor prescribes:

  1. sputum examination;
  2. X-ray of the lungs;
  3. peak flowmetry;
  4. blood and urine tests.

Based on all the data, the doctor can distinguish bronchial asthma from chronic bronchitis. 

Difference from cardiac asthma

Differential diagnosis is also of great importance for the distinction between cardiac and bronchial asthma. It has been established that many diseases of the cardiovascular system, for example, left ventricular failure, can produce symptoms similar to an attack of asthma.

This condition of the patient is called cardiac asthma. In this case, the patient suffers from shortness of breath, severe coughing and palpitations. Asthma attacks can also occur.

With the development of an attack of cardiac asthma, edema of the lungs and bronchi and the release of foamy sputum are possible. In this case, in contrast to an attack of bronchial asthma, it is more difficult for the patient to inhale than exhale.

Also, there is no connection between the deterioration of the patient’s condition and exposure to allergens or other provoking factors.

To relieve an attack, it is often enough to take a nitroglycerin drug.

Due to the similarity of symptoms, the patient must be prescribed an ECG, ultrasound of the heart and X-ray. This will help confirm or rule out cardiac asthma.

Difference from COPD and other lung diseases

COPD (chronic obstructive pulmonary disease) is a disease of the respiratory system with incompletely reversible airway obstruction. It is characterized by an inflammatory process in the tissues of the lungs.

This disease is incurable. In its manifestations, it can be similar to a number of other equally dangerous diseases, such as, for example, bronchial asthma.

That is why the statement of a differential diagnosis in this case is a necessary action for the appointment of the correct treatment.

It is easiest to carry out differential diagnostics in the early stages of the disease, before complications appear. If a patient is suspected of having COPD, testing for asthma is mandatory, as the symptoms of these diseases are similar.

The doctor chooses research methods based on the patient’s condition. However, in any case, there are a number of analyzes that need to be carried out:

  • blood test;
  • radiography of the lungs;
  • sputum examination;
  • assessment of the function of external respiration.

The main differences between COPD and BA include:

  1. Shortness of breath in bronchial asthma is paroxysmal. In COPD, it is constant. If left untreated, symptoms slowly worsen. 
  2. Hereditary predisposition plays an important role in the development of AD. COPD is not related to genetic factors.
  3. COPD often develops in smokers.
  4. AD is most often diagnosed in childhood, and COPD after 40 years.
  5. Allergy symptoms can accompany asthma.
  6. In COPD, bronchial obstruction is irreversible.
  7. Severe COPD causes heart damage.

For diagnosis, a diffuse lung capacity test is often prescribed. With COPD, it is below normal.

In addition to COPD, other lung conditions can cause similar symptoms. The most common are:

  • bronchiectasis;
  • pneumoconiosis.

Differential diagnosis allows you to accurately determine the disease. This is necessary to prescribe the correct treatment.

Differential diagnosis methods

Methods for differential diagnosis of bronchial asthma are quite diverse. To clarify the diagnosis, the doctor uses not only the study and comparison of symptoms. The patient is assigned a variety of tests and examinations.

The patient must undergo blood and urine tests. At the same time, with bronchial asthma, there will be an increased level of immunoglobulin E, eosinophils and ESR (during an exacerbation).

The analysis of the separated sputum is also important for differential diagnostics. It will also show an increased level of eosinophils.

In addition, the patient is prescribed:

  1. Skin tests to identify a disease-provoking allergen.
  2. Peak flowmetry to assess the expiratory flow rate.
  3. Spirometry to study the function of external respiration.
  4. Radiography of the lungs.

Based on all the results obtained, the doctor diagnoses the patient and prescribes treatment.

Differential diagnosis in children

Differential diagnosis of bronchial asthma in children is often difficult due to the fact that a small patient cannot always accurately describe his symptoms.  

The likelihood of an accurate diagnosis is increased if the patient has relatives with AD, or if they have been documented:

  • cases of atopic dermatitis;
  • manifestations of allergic rhinitis, conjunctivitis.

But even if such data are absent, and the child has shortness of breath, wheezing, dry cough and chest congestion, studies to confirm or exclude AD are necessary.

When making a diagnosis, exclude:

  • foreign body getting into breathing bullets;
  • pneumonia and other infectious diseases;
  • cystic fibrosis;
  • dysplasia of the lungs and bronchi;
  • immune deficiency.

After collecting all the data, talking with the parents and the child and conducting the research, the doctor makes a diagnosis.

Actions after confirming the diagnosis

If the doctor has diagnosed bronchial asthma using differential diagnosis, appropriate treatment is prescribed. Depending on the severity of the disease and the patient’s condition, the doctor prescribes drug therapy aimed at relieving symptoms.

Treatment of bronchial asthma is carried out throughout the patient’s life. Even in a state of remission, it is necessary to take measures to prevent seizures. Refusal of medications can cause an exacerbation of the disease and the development of severe complications.

In addition, the patient should reconsider his lifestyle, allocate time for good sleep and rest, give up bad habits and start strengthening the immune system.


Differential diagnosis of bronchial asthma is the most important medical tool that allows you to accurately establish the diagnosis. This is necessary for the most effective care for the patient.

Since many diseases of different organs and systems have similar symptoms, but require different treatment, the doctor must carry out all the stages of diagnosis to establish a differential diagnosis.

event_note August 13, 2020

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