Differentials
Asthma
SIGNS / SYMPTOMS
Clinically indistinguishable.
INVESTIGATIONS
Pre-and post-bronchodilator spirometry: reversibility of obstruction is moderate in AAT deficiency emphysema, while obstruction is usually fully reversible in asthma.
COPD
SIGNS / SYMPTOMS
Long periods of cigarette smoking, advanced age.
INVESTIGATIONS
Obstructive, nonreversible pattern on spirometry, predominantly upper lobe changes on chest x-ray/CT.
Bronchiectasis
SIGNS / SYMPTOMS
Copious daily mucopurulent sputum, history of cystic fibrosis, history of primary ciliary dyskinesia, history of immunodeficiency, history of congenital disorders of the bronchial airways (e.g., Young syndrome, Mounier-Kuhn syndrome, Williams-Campbell syndrome, pulmonary sequestration, yellow nail syndrome).
INVESTIGATIONS
Marked dilation of airways on CT.
Tests for possible causes may demonstrate the CFTR gene or ciliary dysfunction on biopsy.
Viral hepatitis
SIGNS / SYMPTOMS
Positive for risk factors (e.g., blood transfusion, intravenous drug use, overseas travel).
INVESTIGATIONS
Viral hepatitis serology including hepatitis A, B, and C antibodies.
Alcohol-related liver disease
SIGNS / SYMPTOMS
History of excess alcohol consumption, withdrawal symptoms when off alcohol, alcohol tolerance.
INVESTIGATIONS
Reduced carbohydrate-deficient transferrin (CDT), altered gamma-GT, AST, and ALT.
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