What is the most appropriate information to give the parents of a child with bronchial asthma, whose symptoms worsen during upper respiratory tract infections and whose chest X‑ray is normal between attacks?

What to Tell Parents About Pediatric Asthma and Normal Chest X-rays Between Attacks

Between asthma attacks, the chest X-ray is characteristically normal, and this finding is expected and reassuring in children with bronchial asthma. 1, 2

Key Information for Parents

Normal Imaging Between Episodes

• A normal chest X-ray between asthma exacerbations supports rather than contradicts the diagnosis of asthma, as stated by the British Thoracic Society guidelines 1, 2
• Chest radiographs are recommended only to rule out alternative diagnoses in children who present with atypical asthma symptoms; routine imaging between attacks is not indicated 2
• Research confirms that 85% of children with newly diagnosed asthma have normal chest X-rays at follow-up, with any pathological findings being transient 3

Relationship Between Upper Respiratory Infections and Asthma

• Upper respiratory viral 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 viruses trigger bronchospasm and inflammation, not because asthma makes them more prone to catching infections 2

Diagnostic Approach

• The diagnosis of asthma in children is based on clinical features (particularly wheezing heard on auscultation), a positive response to bronchodilator therapy, and ongoing reassessment—not on chest X-ray findings 1, 2
• Wheezing heard by a health professional on auscultation should prompt suspicion of asthma and must be differentiated from upper airway noises 1, 2

When Imaging Is Needed

• 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
• During acute severe attacks requiring hospitalization, chest X-rays may be obtained to exclude complications such as pneumothorax, pneumomediastinum, or pneumonia 1

Common Pitfalls to Avoid

Parents should understand that monitoring of pediatric asthma should rely on symptom evaluation, peak-flow measurements (when age-appropriate), and response to therapy—not on repeated chest imaging 2. The absence of X-ray abnormalities between attacks does not mean the asthma is "not real" or doesn't require treatment; it simply reflects the episodic nature of the disease.