Asthma-Like Conditions

​Some common symptoms of asthma include shortness of breath, wheezing, coughing, and chest tightness. To make a diagnosis, your doctor will look at your medical history and perform a physical exam. They may also do lung function tests.

Other respiratory conditions can have similar symptoms to asthma but require different treatments. That’s why it’s important to get an accurate diagnosis.

One study showed that one out of three people diagnosed with asthma didn’t actually have the condition.³

What Conditions Are Similar to Asthma?

Here are some other health conditions that can have signs and symptoms similar to asthma:

• Acid reflux (gastroesophageal reflux disease or GERD)
• Allergies (such as pollen, animal dander, dust mites, and mold)
• Aspiration
• Bronchiectasis
• Bronchiolitis, typically caused by respiratory syncytial virus (RSV) infections
• Bronchopulmonary dysplasia
• Chronic obstructive pulmonary disease (COPD – emphysema or chronic bronchitis)
• Congestive heart failure
• Cystic fibrosis
• Enlarged lymph nodes that impact the airway and lungs
• Heart attack
• Hiatal hernia
• Lung cancer (tumors)
• Obesity
• Parasitic infections
• Pneumonia
• Pulmonary edema
• Pulmonary embolism
• Recurrent cough not due to asthma
• Sinus infections
• Transient wheeze not due to asthma (wheezing that begins in an infant’s first year and goes away or resolves by their 3rd year)
• Upper airway obstruction (something that blocks the airway such as tracheal stenosis, benign airway tumor, malignant tumor, goiter, tracheomalacia, right-sided aortic arch, or other upper airway obstruction)
• Viral infections (such as the flu, RSV, rhinovirus, COVID-19)
• Vocal cord dysfunction or paralysis

Make sure you talk with your doctor if your asthma treatment is not controlling your symptoms. Getting the right diagnosis can mean a better quality of life. For some more serious conditions, it can be the difference between life and death. These other conditions may need other specific treatments. Also, you may need other testing to rule out or confirm conditions other than asthma.

When asthma doesn’t respond to asthma medicine, some doctors prescribe oral corticosteroids. One example is prednisone. This medicine is only for short-term use. Using oral corticosteroids long term due to the wrong diagnosis may have harmful side effects. This is another reason why getting an accurate diagnosis is so important.

How Do I Know If I Have Been Misdiagnosed with Asthma?

If you have been following an asthma treatment plan but it isn’t helping, talk with your doctor. They may have you do a test called a methacholine [meth-uh-KOH-leen] challenge. This test can be performed on people 5 years of age and older.

Methacholine is a type of drug that will tighten your airways at a lower dose if you have asthma. Your airways will tighten at a higher dose or not at all if you do not have asthma. At the beginning of the test, the doctor will have you do a baseline spirometry test (specific type of breathing test). During this test, your doctor will have you breathe in increasing doses of methacholine at scheduled periods over time. Then they will do repeat spirometry tests after each dose to see if your lung function changes. There are guidelines to follow if there are major decreases in lung function and when to stop this challenge.

If your lung function goes down a lot during the test, that means you could have asthma. People without asthma should be able to go through the entire test without a major drop in their lung function.

If your lungs do not react to lower doses of methacholine, you may have another condition that has similar symptoms to asthma (see list above). Your doctor can help find the most appropriate diagnosis so they can create an effective treatment plan.