Fast Five Quiz: Differential Diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

Zab Mosenifar, MD


February 04, 2022

Figure 1. Illustration of the bronchi (airways) in COPD.

Chronic bronchitis and emphysema are considered the two main types of COPD. Chronic bronchitis is defined as the presence of a chronic, productive cough for 3 months during 2 consecutive years, whereas emphysema is defined as an abnormal, permanent enlargement of the air spaces that is distal to the terminal bronchioles and accompanied by destruction of their walls and without obvious fibrosis. Patients typically present with a combination of symptoms from both diseases, including cough, breathlessness, and wheezing.

Pulmonary hypertension is a common complication of COPD; its presence is associated with shorter survival and worse clinical evolution. In COPD, pulmonary hypertension tends to be of moderate severity and progresses slowly.

COPD exacerbations are often offset by respiratory infections, for example, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, and Pseudomonas aeruginosa. For this reason, sputum analysis in the form of culturing is always a useful tool in determining the most common bacteria in an infection.

Lung cancer is a differential diagnosis of COPD and both diseases share some similar symptoms, namely, cough and dyspnea upon exertion. Recurring episodes of bronchitis and pneumonia are also seen in both diseases. However, lung cancer (both small cell lung cancer and non–small cell lung cancer) have other symptoms, including loss of appetite, weight loss, and coughing up blood. According to Durham and colleagues, COPD is a risk factor for developing lung cancer and the two diseases are linked beyond a common etiology.

Learn more about the types of COPD.


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