Conditions That Mimic Asthma

Asthma is a condition characterized by coughing, wheezing and shortness of breath. But many other conditions that mimic asthma may cause misdiagnosis. Knowing about these conditions can help in proper diagnosis and management of your condition.

Bronchial asthma is a serious concern for many patients, families, and society as a whole. Some reports note that more than 22 million Americans suffer from chronic asthma.1 It is considered as one of the commonest chronic diseases of childhood affecting about 6 million children.1

While asthma is a respiratory illness requiring medical care and attention, there are other conditions too that may appear like asthma. It is necessary to know about the conditions that mimic asthma, to be able to differentiate and diagnose and help in planning appropriate treatment.

What is Asthma?

Asthma is a condition in which the respiratory airways get narrowed and swell due to the extra production of mucus. This makes it difficult to breath, produces a cough and causes a whistling sound called wheezing.2

The Global Initiative in Asthma (GINA) task force has defined asthma as, ‘a heterogeneous disease, usually characterized by chronic airway inflammation defined by the history of respiratory symptoms such as wheeze, cough, chest tightness and shortness of breath that vary over time and intensity, together with airway limitation.’ 3

The symptoms of asthma, the frequency, and their intensity vary from person to person. Also, in the same person, the symptoms may fluctuate depending on various factors. This not only makes it difficult to diagnose but sometimes, management becomes challenging. Studies have shown that the main reasons why asthmatics fail standard treatment are an incorrect diagnosis and failure to identify the underlying contributing factors.1

However, with a proper understanding of the conditions that mimic asthma, doctors can diagnose and treat the condition. This information can help you to understand your symptoms better and discuss with your doctor about the diagnosis and treatment.

Conditions That Mimic Asthma

Experts believe that if there is no variability in your asthma symptoms, there may be three reasons – the diagnosis is wrong, severe, uncontrolled asthma has turned into asthma/chronic obstructive pulmonary disease overlap syndrome or the condition might have resolved, which often occurs in children.4 Keeping these in mind, the conditions that mimic asthma must be studied carefully and always considered when making a diagnosis of asthma and even when managing the condition later on.

As asthma symptoms are similar to complaints of other health conditions, your doctor may consider those before making a diagnosis. You may be advised to undergo investigations to rule out other causes, in addition to the tests for asthma before confirming the diagnosis.

Some of the conditions that mimic asthma include:

Chronic Obstructive Pulmonary Disease (COPD) – COPD presents with symptoms very similar to asthma, like cough, wheezing, breathing difficulty, chest tightness, and airflow obstruction. The common conditions in COPD are emphysema and bronchitis. COPD and asthma are commonly seen in the elderly and both may even overlap.

Although the physiology and treatment for both, in most cases, maybe similar, differentiation and precise diagnosis are important for patient management. While both have chronic inflammation, the triggers and the type of inflammatory response differ, based on which clinical management and prognosis can also differ.

Rhinosinusitis – Running nose or nasal congestion can cause difficulty in breathing. Rhinitis and sinusitis are upper respiratory problems causing inflammation, stuffy nose, pain in the forehead or upper jaw area. These may be associated with nasal polyps. Studies have shown that rhinovirus infections play an important role in the development of asthma as they are a major cause of the development of early childhood wheezing, asthma exacerbations.3 As these conditions can coexist with asthma, they need to be properly diagnosed and treated.

Myocardial Ischemia – This is a condition of the heart, where the blood flow to the heart gets disrupted, often due to a clot in the arteries to the heart. This results in a heart attack, characterized by chest pain, shortness of breath, neck, shoulder or jaw pain and sometimes cough, and vomiting.

Angina – Angina is a type of chest pain caused due to reducing blood flow to the heart. It is experienced as squeezing pain, pressure in the chest, and sometimes difficulty in breathing.

Anxiety – While it is normal to experience worry or be anxious occasionally, ongoing anxiety can cause disturbances to a great extent. Generalized anxiety can cause an inability to relax or sleep, muscle tension or pain, sweating, irritability, nausea, and sometimes shortness of breath.

Gastroesophageal Reflux Disease / Aspiration GERD – This is a gastroesophageal problem, in which the stomach content and acid flow back into the esophagus, causing heartburn and chest pain. It is also one of the conditions that mimic asthma, as it may begin suddenly in an episodic manner and also cause cough and shortness of breath. Sometimes, the regurgitated stomach contents may be aspirated, causing inflammation of the lungs or pneumonia in aspiration GERD.

Vocal Cord Dysfunction/ Paralysis – Vocal cord dysfunction is a disorder involving the paradoxical inappropriate motion of the vocal cords, resulting in shortness of breath and stridor on inspiration. It is more common in women and young girls, possibly due to stress or irritants like chemicals. Due to its episodic nature and stridor that sounds like wheezing, it can be easily confused with asthma.3 Exercise-induced form of vocal cord dysfunction can occur, which is not due to stress and is often seen in young athletes.

Viral Infections – Viral infections affect people in various ways and respiratory complaints being the commonest. A respiratory syncytial virus (RSV) infection can affect children, cause wheezing, and lower respiratory illness. Other viral infections like the coronaviruses too can affect the respiratory tract and present with symptoms of cough, shortness of breath, and fever.

Obesity – Respiratory symptoms associated with obesity is one of the common conditions that mimic asthma. Obesity is often characterized by low-grade systemic inflammation due to excess adipose tissue, with higher C-reactive protein and other inflammatory markers in obese persons. Obesity is another cause of shortness of breath and obesity-associated asthma is also a phenotype of asthma.3 It can present with airway inflammation, decreased lung volumes, and poor asthma control.

Some of the less common conditions that mimic asthma include the following.5

Heart failure – This too is a heart condition, in which the heart is unable to pump blood effectively, which can lead to a buildup of fluid in the body. It is characterized by shortness of breath, fatigue, inability to exercise or cough or wheezing, swelling in the leg, feet, or fluid accumulation in the abdomen (ascites). This is one of the important possible conditions that mimic asthma and often needs immediate medical attention.

Pulmonary Embolism – This condition occurs due to blockage of an artery in the lungs due to a substance, mostly a clot or a thrombus, moved from some other location in the body. It can present with shortness of breath, wheezing,

Cystic Fibrosis – Cystic fibrosis may present with gastrointestinal malabsorption symptoms, shortness of breath, and cough with airflow obstruction. This condition should be considered when persistent airway disease, wet cough, recurrent chest infections, finger clubbing and failure to thrive is present.3

Bronchiolitis Obliterans – Other infections like cytomegaloviruses, adenoviruses, measles, varicella, exposure to toxins, or certain drugs can cause bronchiolitis obliterans. It can present with a wheezing, dry cough, breathing difficulty, and airflow obstruction.

Bronchiectasis – Bronchiectasis too is a respiratory condition characterized by permanent dilation of bronchi, causing persistent cough, production of sputum, and recurrent pneumonia.

Hypersensitivity Pneumonitis – This is a hypersensitivity reaction, often caused due to exposure to exposure to allergens like moldy hay, birds. It can present with shortness of breath, sometimes cough, chills, fever, and flu-like symptoms.

Airway Obstruction – Airway obstruction is the blocking of the air passage, partially or totally, thus preventing air from getting into the lungs. The obstruction can occur in the upper or lower airways and develop conditions that mimic asthma. Airway obstruction can occur due to various causes like a foreign body, trauma, allergic reaction, edema, abscesses, growth, or tumors affecting the airflow in the respiratory passages. It can present with difficulty in breathing, wheezing, cough or choking feeling, and gasping for air.

Some uncommon conditions that mimic asthma may include tropical eosinophilia, pulmonary infiltration with eosinophilia, chronic eosinophilic pneumonia, aspergillosis, Churg Strauss syndrome, Loffler syndrome, metastatic carcinoid, systemic mastocytosis, lymphangioleiomyomatosis, and bronchogenic carcinoma.

Considering the list of conditions that mimic asthma, it is important to consider the possibility of any of these conditions, based on the individual’s health. Most conditions have relevant investigations, performing which can help to rule out or confirm the diagnosis. This can not only help in understanding asthma-like symptoms but also help doctors evaluate the presence of co-existing ailments in asthma patients.

Your medical history, family history, and evaluation of symptoms, along with the investigations can give a fair understanding of the condition. This can make it possible to confirm the diagnosis, whether it is asthma or it is one of the conditions that mimic asthma or some of those conditions are present in addition to existing asthma. Such evaluations are important to plan proper treatment and self-management regime.

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