Which statement is correct to tell the parents of a child with bronchial asthma whose episodes worsen during upper respiratory tract infections and whose chest X‑ray is normal between attacks?

Chest X-Ray Findings Between Asthma Attacks in Children

Between asthma attacks, the chest X-ray is characteristically normal, and this is an expected and reassuring finding that supports rather than contradicts the diagnosis of bronchial asthma. 1

Understanding Normal Imaging Between Exacerbations

The British Thoracic Society guidelines explicitly state that chest radiographs should be performed only to rule out alternative diagnoses in children who present with atypical asthma symptoms—routine imaging between attacks is not indicated. 1 This is because:

• A normal chest X-ray between episodes is expected in asthma, as demonstrated in multiple studies showing 85% of newly diagnosed asthmatic children have normal chest films at follow-up. 2
• The diagnosis of asthma in children is based on clinical features (especially wheezing on auscultation), a positive response to bronchodilator therapy, and ongoing reassessment—not on chest X-ray findings. 1
• Research confirms that pathological findings on chest X-rays in asthmatic children are typically transient and resolve between attacks. 2

Addressing the Specific Answer Choices

Option C is Correct: "Between attacks, the chest X-ray is normal"

This statement accurately reflects the expected clinical course and is supported by high-quality guideline evidence from the British Thoracic Society. 1 The normal chest X-ray between exacerbations is reassuring and does not exclude the diagnosis of asthma. 1

Option A is Incorrect: "Bronchial asthma increases the risk of upper respiratory tract infections"

This statement reverses the actual relationship. Upper respiratory viral infections are common triggers that precipitate asthma exacerbations; asthma itself does not increase susceptibility to these infections. 1 The child's asthma worsens during URIs because viruses trigger bronchospasm and airway inflammation, not because asthma makes them more prone to catching infections. 3

Option B is Incorrect or Incomplete: "Polyphonic wheeze occurs on exertion (not exercise)"

While wheezing is a cardinal feature of asthma, the British Thoracic Society emphasizes that wheezing heard on auscultation by a health professional should prompt suspicion of asthma and must be differentiated from upper-airway noises. 1 The distinction between "exertion" and "exercise" is not clinically meaningful or supported by guideline evidence, and this statement does not address the parent's concern about the normal chest X-ray.

Key Clinical Pearls for Parent Education

When counseling parents about their child's asthma diagnosis:

• Reassure them that a normal chest X-ray between attacks is expected and does not mean the diagnosis is wrong. 1
• Explain that viral URIs are common triggers for asthma exacerbations, but having asthma does not make their child more susceptible to catching colds. 1
• Emphasize that monitoring should rely on symptom evaluation, peak-flow measurements (when age-appropriate), and response to therapy—not on repeated chest imaging. 1
• Chest radiographs should only be repeated if atypical symptoms develop or if the child fails to respond to appropriate asthma treatment. 1

Common Pitfall to Avoid

Do not order repeated chest X-rays to "monitor" asthma control between exacerbations. This exposes children to unnecessary radiation (with estimated 10-fold increased lifetime cancer risk compared to adults) 4 and provides no useful clinical information, as the films are expected to be normal. 1, 2