Appropriate Information for Parents of a Child with Bronchial Asthma and Normal Chest X-ray
Between asthma attacks, the chest X-ray is characteristically normal, and this finding is both expected and reassuring in children with bronchial asthma. 1, 2
Understanding Normal Chest X-rays in Asthma
A normal chest radiograph between episodes supports rather than contradicts an asthma diagnosis, as the British Thoracic Society guidelines emphasize that chest X-rays are performed to rule out alternative diagnoses in patients with atypical symptoms, not to diagnose asthma itself. 1, 2
Research confirms that 73-85% of children with asthma have normal chest X-rays between attacks, with pathological findings typically being transient and related to acute exacerbations or complications rather than the underlying asthma. 3, 4
The diagnosis of asthma in children is based on clinical features (wheezing, symptom patterns), response to bronchodilator therapy, and ongoing reassessment—not on chest X-ray findings. 1, 2
Addressing the Relationship Between URIs and Asthma
Upper respiratory tract infections are common triggers that precipitate asthma exacerbations; however, asthma itself does not increase susceptibility to these infections. 2 This is an important distinction—the child's asthma worsens during URIs because viral infections trigger bronchospasm and airway inflammation, not because asthma makes them more prone to catching infections.
Viral respiratory infections are the most common trigger for asthma exacerbations in children, which explains why symptoms worsen during upper respiratory tract infections. 5
When to Repeat Chest Imaging
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 such as pneumonia, foreign body aspiration, or other lung diseases. 1, 2
Routine chest X-rays are not indicated for monitoring asthma control between attacks; instead, monitoring should rely on symptom evaluation, peak flow measurements, and response to therapy. 2
Common Pitfalls to Avoid
Do not interpret a normal chest X-ray as evidence against asthma—this is the expected finding between attacks and should reassure parents that there is no structural lung damage or alternative pathology. 2, 3
Avoid ordering repeated chest X-rays for routine asthma monitoring, as this exposes the child to unnecessary radiation without clinical benefit. 3