Shortness of Breath with Wheezing, with or without Cough

CLINICAL DIAGNOSTIC MANUAL

Shortness of breath with wheezing is a common symptom that can present with or without cough, posing a significant diagnostic challenge for physicians. Identifying the underlying cause is crucial for effective management and a better prognosis for the patient.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Asthma	Shortness of breath, wheezing, chest tightness, often with a history of episodic symptoms.	Clinical history and physical examination, history of allergies or atopy.	Spirometry, bronchial provocation test.
Chronic obstructive pulmonary disease (COPD)	Chronic cough, sputum production, wheezing, and dyspnoea, typically in a smoking history.	History of smoking, clinical examination.	Pulmonary function tests, chest X-ray.
Respiratory infections (e.g., bronchiolitis, pneumonia)	Fever, cough, wheezing, shortness of breath, and possible chest pain.	Clinical evaluation, history of recent infections.	Chest X-ray, sputum culture, blood tests.
Heart failure	Shortness of breath, wheezing (cardiac asthma), oedema, fatigue, orthopnoea.	Clinical evaluation, history of cardiac disease.	Echocardiogram, BNP (B-type natriuretic peptide) levels, chest X-ray.
Foreign body aspiration	Sudden onset of wheezing, coughing, and choking, often in children or elderly patients.	History of sudden symptom onset, physical examination.	Bronchoscopy, chest X-ray.
Gastroesophageal reflux disease (GERD)	Wheezing, chronic cough, symptoms worse at night or after meals.	Clinical history of reflux symptoms, physical examination.	pH monitoring, upper endoscopy.
Anaphylaxis	Acute onset of wheezing, shortness of breath, swelling, rash, and hypotension.	History of allergen exposure, clinical evaluation.	Clinical diagnosis, serum tryptase levels.