Best Information for Parents of a Child with Bronchial Asthma
Between asthma attacks, the chest X-ray is characteristically normal, which is an expected and reassuring finding that supports rather than contradicts the diagnosis of asthma.
Understanding Normal Chest X-rays in Asthma
The correct answer is Option C: Between attacks, the chest X-ray is normal. This is the most important educational point for parents to understand about their child's condition.
Why This Information Matters
A normal chest X-ray between episodes is expected and reassuring in asthma, as stated by the British Thoracic Society guidelines, which recommend chest radiographs primarily to rule out alternative diagnoses in patients with atypical symptoms 1.
The diagnosis of asthma in children is based on clinical features, response to bronchodilator therapy, and ongoing reassessment—not on chest X-ray findings 1, 2.
Research confirms that 73-85% of children with asthma have completely normal chest X-rays, even during their asthmatic episodes, particularly those with intermittent symptoms 3, 4.
What Parents Should Understand
Physical examination and chest X-rays may be completely normal between episodes, but this does not rule out asthma, as the disease is variable and signs may be absent between attacks 5.
Chest radiographs should be repeated only if atypical symptoms develop or if the child fails to respond to appropriate asthma treatment, which would prompt investigation for alternative diagnoses 2.
The normal X-ray at this visit is consistent with the episodic nature of asthma and does not indicate that the diagnosis is incorrect 1.
Why Other Options Are Incorrect
Option A: Asthma Increases Risk of Upper Respiratory Infections
This statement is backwards—upper respiratory tract infections are common triggers that worsen asthma symptoms, not consequences of having asthma 1.
The relationship is that viral infections precipitate asthma exacerbations, not that asthma increases susceptibility to infections 1.
Option B: Polyphonic Wheeze on Exertion
While wheeze is a key symptom of asthma, this statement is too narrow and not the most important educational point for parents at this visit 1, 5.
The normal chest X-ray finding is more directly relevant to the clinical scenario presented and addresses a common parental concern about whether imaging is needed 2.
Clinical Implications for Management
Asthma should be suspected in any child with wheezing heard by a health professional on auscultation, distinguished from upper airway noises 1.
Routine chest X-rays need not be part of the initial routine work-up of asthma in children, as they rarely change management unless performed for specific clinical indications 4.
Parents should understand that monitoring is based on symptoms, peak flow measurements, and response to treatment—not on repeated imaging 1.