Differential Diagnosis: Is It Asthma, Or Something Different?

Differential Diagnosis: Is It Asthma, Or Something Different

So, what if it’s not asthma after all?  What if your shortness of breath, chest tightness, coughing, and wheezing are caused by something else?  Unless you have an obvious family history for asthma, most physicians will likely perform some tests to make sure you have asthma and not one of the other diseases that mimic it’s symptoms.

The most common chronic disease diagnosed in childhood is asthma. So, if a child presents with shortness of breath, and once other diseases are ruled out, asthma is the likely conclusion. Likewise, about 10-15% of asthmatics overall present with severe asthma, or asthma that is poorly controlled despite the highest doses of one or more asthma controller medicines.

Of course, for asthma medicines to control symptoms, asthma must be present. So, it’s only logical for physicians to perform some tests to make sure your symptoms are caused by asthma. While there is no one test to diagnose asthma, ruling out other potential causes often leaves asthma as the only logical diagnosis.

What is a "differential diagnosis"?

The quest to rule out other causes of asthma-like symptoms, or to rule in asthma as the likely cause, is called differential diagnosis. If it’s not asthma, that’s important to know, because the strategy for obtaining ideal control of your symptoms is likely to be different than the strategy for treating asthma.

With that said, here are some of the most likely culprits that may mimic asthma.

For children they may include.

Some people have allergies that can make them feel stuffy and short of breath. Allergy testing may reveal allergies, although pulmonary function testing may indicate normal lung function, thereby ruling out asthma and ruling in allergies. Of course allergies

Vocal Cord Dysfunction

Like asthma, it can cause a dry cough, shortness of breath, chest tightness,  and wheezing. However, these symptoms are caused by an abnormal closing of your vocal cords when you exhale. Similar to asthma, this can happen when you are exposed to certain airway irritants. It can be suspected when asthma medicines don’t work and it feels harder to breathe in than out.1-7

Cystic Fibrosis (CF) or Bronchiectasis

CF is a disease that results in shortness of breath, wheezing, and a cough that may be productive of phlegm. While asthma may be a component of their syndrome, it is also associated with chronically progressing bronchiectasis. Bronchiectasis is a condition caused by permanent inflammation and dilation of airways also associated with thick, crusty secretions that increase the likelihood of lung infections that contribute to flare-ups. While asthma medicines may help, they usually also require things like frequent antibiotics, enzyme supplements, proper nutrition, among other things not commonly prescribed for asthma.2-3

Chronic Obstructive Pulmonary Disease (COPD)

It can cause loss of lung function that results in shortness of breath, coughing, chest tightness, and wheezing -- just like asthma. However, unlike asthma, shortness of breath due to COPD is only partially reversible. This means that some degree of shortness of breath may be present at all times. While many COPD medicines are the same as for asthma, COPD usually needs to be treated with a different approach compared to how asthma is treated. You can learn more by checking out our sister site COPD.net

Congestive Heart Failure (CHF) This is a condition where your heart becomes too weak to effectively pump blood through your body. It may cause swelling of your feet and ankles. Blood can become backed up in your lungs causing what is called pulmonary edema. The symptoms of a  CHF flare-up are shortness of breath and wheezing. If properly diagnosed it can be treated and controlled with medicines to remove the excess fluid and strengthen your heart. You can learn more about CHF in our article, "What is heart failure?"

Other culprits that may affect both adults and children.


Studies show that up to a third of the obese population is misdiagnosed with asthma. Obesity can cause the feeling you can’t catch your breath and wheezing, especially with physical exertion. Like asthma, obesity can make it difficult to participate in physical activity. However, unlike asthma, shortness of breath in the obese is caused by the inability to take in a full, deep breath due to excessive fat tissue on the chest wall and abdomen. Studies seem to suggest that obesity related shortness of breath is not caused by cardiac de-conditioning but by increased oxygen demand by their body’s during exertion. Rather than asthma medicines, treatment involves education, diet and exercise.4, 7

Foreign Body Aspiration (Upper Airway Obstruction)

This is when food or other small objects are accidentally inhaled and become lodged in the upper airway. This causes shortness of breath, coughing, chest pain, and wheezing, similar to asthma. When this happens in adults, it usually occurs in those with neurological disorders, Parkinson's disease, strokes, the mentally challenged, airway or esophagus abnormalities, the elderly, or alcohol or drug abusers. It is most likely to occur in small children. This condition may last for months or years, mainly because those who have it are unable to describe a choking episode or explain their symptoms. Diagnosis is usually made by x-ray or bronchoscopy. The remedy here is removal of the object, which should be done by medical professionals after a proper diagnosis is made.5-6

Gastrointestinal Reflux (GERD)

This is when small amounts of stomach contents work their way back up the esophagus and into your airway. It’s most likely to happen in adults, although it can also be diagnosed in childhood. Treatment involves changing your diet and medicines to reduce stomach acid.

Lung Cancer (tumors)

It can obstruct airways and cause shortness of breath, coughing, chest tightness and wheezing. Treatment involves chemotherapy, radiation therapy, surgery, etc. You can learn more about lung cancer by checking out our sister site: lungcancer.net

A differential diagnosis may be conducted when you first present to your doctor with asthma-like symptoms. It may also be done after your doctor determines you have asthma that doesn't respond to treatment. Some experts suggest that about a third of difficult to treat asthmatics do not have asthma: they have something different.

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