Acute Respiratory Difficulty with Wheezing and Cough

CLINICAL DIAGNOSTIC MANUAL

Acute respiratory difficulty with wheezing and cough typically indicates airway obstruction. The most common causes include respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD), though it can also result from respiratory infections or even cardiovascular conditions, such as left ventricular failure. These symptoms require rapid and thorough evaluation, as some causes can be potentially life-threatening, such as anaphylaxis. Management will depend on identifying the underlying cause through a combination of physical examination and complementary tests.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Acute asthma	Respiratory difficulty, wheezing, cough, chest tightness, especially during the night or early morning.	Audible wheezing, history of previous asthma episodes.	Spirometry showing reversible airway obstruction. Improvement after bronchodilator use.
Acute COPD	Progressive shortness of breath, chronic cough with sputum, wheezing. Patient with a history of smoking.	History of exposure to tobacco or pollutants. Acute exacerbation of shortness of breath and cough.	Spirometry showing irreversible airway obstruction. Chest X-ray showing signs of pulmonary hyperinflation.
Bronchitis (viral or bacterial)	Persistent cough, occasional fever, wheezing, mild to moderate shortness of breath. Sputum production in bacterial cases.	Persistent cough with fever and shortness of breath, history of recent respiratory infection.	Positive sputum culture in bacterial cases. Chest X-ray without significant findings (to rule out pneumonia).
Left ventricular failure	Acute shortness of breath worsened by lying down, cough, wheezing, orthopnoea, lung crackles, lower limb oedema.	History of heart failure, acute shortness of breath with wheezing and crackles.	Chest X-ray showing signs of pulmonary oedema. ECG showing cardiac overload. Echocardiogram revealing ventricular dysfunction.
Anaphylaxis	Sudden onset of respiratory difficulty, wheezing, facial and throat swelling, urticaria, hypotension, gastrointestinal symptoms.	History of allergen exposure, sudden onset of symptoms.	Clinical diagnosis based on the onset of symptoms. Allergy testing to identify the responsible allergen. Requires immediate treatment with adrenaline.