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Cough is one of the most frequent complaints among patients. In the present case, a 35-year-old Asian male comes into the clinic stating that his cough has been persistent for two weeks. The cough is productive of sputum and is followed by fever, malaise, and myalgia. The examination shows that the patient has a low-grade fever, scattered rhonchi, and mild wheezing. The review of the patient’s history, physical exam, and x-ray suggests a primary diagnosis of acute bronchitis and differential diagnoses of COPD, pneumonia, and asthma.
The primary diagnosis for the patient is acute bronchitis, an inflammation of the bronchi and the trachea. This condition is characterized by a cough that lasts from one to three weeks and can be with or without sputum production (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). Other symptoms include low-grade fever, occasional wheezing, rhonchi, and dyspnea (Kinkade & Long, 2016). The patient’s complaints suit this description fully, and his malaise and myalgia indicate that this may be a viral upper respiratory tract infection.
The first differential diagnosis is asthma, a chronic condition of the airways. It is defined by dyspnea and chest tightness, wheezing, and persistent cough (Aaron et al., 2017). The x-ray of the patient cannot detect asthma, so the patient’s history is the only present data that one has for this case. However, asthma is not characterized by fever, and the patient does not talk about chest tightness or dyspnea which weakens the diagnosis.
The second differential diagnosis is pneumonia, an infection of the lungs. It is a severe condition that can present with productive cough, fever, fatigue, chest pain, nausea, and dyspnea (Buttaro et al., 2017). The patient’s x-ray results do not show any airspace opacity or lobar consolidation, thus making the diagnosis of pneumonia less probable than others (Buttaro et al., 2017). In this case, the x-ray plays a significant role in examining the patient.
Finally, one may propose chronic obstructive pulmonary disease (COPD) as the final differential diagnosis. This disease is defined by the inflammation of the lungs, resulting in cough, sputum production, breathing difficulty, and wheezing (Buttaro et al., 2017). Similar to the previously described condition, an x-ray may be indicative of COPD if it shows emphysema (Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2017). Since the diagnostic test does not reveal any changes in size or presence of fluids in the organs, the diagnosis of COPD is not fully supported.
Acute bronchitis with a viral origin may require only symptomatic treatment because this condition usually passes on its own. Thus, it is vital not to overprescribe antibiotics to the patient (Kinkade & Long, 2016). The patient can benefit from resting for several days, drinking enough fluids, and removing himself from areas with polluted or dry air. To clear the airways from mucus, he can take guaifenesin 200 mg orally every four hours as needed (“Guaifenesin,” 2019). Overall, the cough should pass without additional treatment, but the rest is advisory.
The patient’s history, physical exam, and tests allow a clinician to make an informed decision and come up with multiple possible causes. In this case, cough is a general complaint, but other symptoms such as low-grade fever, wheezing, and malaise point to a diagnosis of acute bronchitis. Differential diagnoses, such as asthma, pneumonia, and COPD, are not supported by presented evidence. The patient’s treatment should include rest, fluids, and symptom management, if necessary.
Aaron, S. D., Vandemheen, K. L., FitzGerald, J. M., Ainslie, M., Gupta, S., Lemière, C.,… Boulet, L. P. (2017). Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA, 317(3), 269-279.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Global Initiative for Chronic Obstructive Lung Disease. (2017). At-a-glance outpatient management reference for chronic obstructive pulmonary disease (COPD). Web.
Guaifenesin. (2019). Web.
Kinkade, S., & Long, N. A. (2016). Acute bronchitis. American Family Physician, 94(7), 560-565.