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, 2
Understanding Normal Imaging Between Exacerbations
- A normal chest X-ray between episodes is the typical finding in pediatric asthma and does not rule out the diagnosis. 2, 3
- The British Thoracic Society explicitly states that chest radiographs should be performed only to rule out alternative diagnoses in children with atypical symptoms, not as routine monitoring between attacks. 1, 2
- In one study of 60 preschool children with newly diagnosed asthma, 85% had completely normal chest X-rays at follow-up, and any pathological findings were transient. 3
Why the Chest X-Ray is Normal Between Attacks
- Asthma is characterized by reversible airway obstruction and inflammation that resolves between exacerbations, leaving no permanent radiographic changes in uncomplicated cases. 1, 2
- During acute exacerbations, chest X-rays may show hyperinflation (increased air volume, low diaphragms, wide diaphragmatic angles), but these findings disappear when the child is asymptomatic. 4
- The diagnosis of asthma in children is based on clinical features (especially wheezing on auscultation), response to bronchodilator therapy, and ongoing reassessment—not on chest X-ray findings. 1, 2
Addressing the Other Answer Options
Option A: Does Asthma Increase Risk of Upper Respiratory Infections?
- This statement is incorrect. Upper respiratory viral infections are common triggers that precipitate asthma exacerbations, but asthma itself does not increase susceptibility to these infections. 2
- The American Thoracic Society/European Respiratory Society notes that in young children with asthma, exacerbations are frequent, with significant morbidity, possibly because of the frequency of viral infections—but this reflects viral triggers causing exacerbations, not increased infection susceptibility. 1
Option B: Polyphonic Wheeze on Exertion
- While wheezing is a cardinal feature of asthma, this statement is incomplete and less informative for parents compared to explaining the normal chest X-ray finding. 1
- The British Thoracic Society recommends that asthma should be suspected in any child with wheezing heard by a health professional on auscultation, but this doesn't specifically address the question about what to tell parents regarding the normal chest X-ray. 1, 2
Clinical Implications for Parent Education
- Parents should be reassured that a normal chest X-ray between attacks is expected and does not mean the diagnosis is wrong. 2, 3
- 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. 1, 2
- 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, 5
When Chest X-Rays Are Indicated
- Chest X-rays are appropriate during severe exacerbations requiring hospitalization to exclude complications such as pneumothorax, pneumomediastinum, or pneumonia. 1, 2
- In one study of hospitalized asthmatic children, only 10% of chest X-rays altered the treatment plan, and these were primarily in children with fever or oxygen saturation ≤92%. 6
- The British Thoracic Society recommends chest X-rays for children with atypical features such as symptoms present from birth, persistent wet cough, failure to thrive, or unexpected clinical findings. 1