Information for Parents of a Child with Asthma and Normal Chest X-Ray
A normal chest X-ray between asthma episodes is expected and reassuring, as it supports rather than contradicts the diagnosis of asthma. 1
Key Information to Provide Parents
Normal Chest X-Ray Between Attacks
The normal chest X-ray finding is characteristic of asthma and should be reassuring to parents. 1 The British Thoracic Society guidelines explicitly state that a normal chest radiograph between episodes is expected in asthma and supports the diagnosis rather than contradicting it. 1
Chest radiographs in asthma are primarily used to rule out alternative diagnoses in patients with atypical symptoms, not to confirm asthma itself. 1 The diagnosis is based on clinical features, response to bronchodilator therapy, and ongoing reassessment—not on imaging findings. 1
Repeat chest X-rays should only be obtained if atypical symptoms develop or if the child fails to respond to appropriate asthma treatment, which would prompt investigation for alternative diagnoses. 1
Relationship Between Upper Respiratory Infections and Asthma
Upper respiratory tract infections trigger asthma exacerbations rather than being caused by asthma. 2 The typical presentation of pediatric asthma includes recurrent episodes of wheezing and/or cough triggered by viral upper respiratory infections. 2
Children with asthma often take longer than the usual week to fully recover from their respiratory symptoms after a viral URI. 2 This prolonged recovery is a characteristic feature that helps distinguish asthma from simple viral infections.
Viral infections can cause bronchial hyperreactivity even in normal persons, and this associated bronchial irritability may take months to clear. 3 This explains why asthma symptoms persist or worsen during and after URIs.
Clinical Features and Diagnosis
Asthma should be suspected when wheezing is heard by a health professional on auscultation, distinguished from upper airway noises. 1 Additional triggers include exercise, laughing, crying, and changes in weather. 2
A trial of bronchodilator medication should show symptomatic improvement, which helps confirm the diagnosis. 2
Common Pitfalls to Avoid
Do not interpret a normal chest X-ray as ruling out asthma—this is the expected finding between episodes. 1
Parents should understand that asthma does not increase susceptibility to URIs; rather, URIs are common triggers that unmask or worsen underlying asthma. 2, 3
Avoid unnecessary repeat imaging unless clinical status changes or the child fails to respond to appropriate treatment. 1