What Parents Should Be Told About Normal Chest X-Ray Between Asthma Attacks
Between attacks, the chest X-ray is characteristically normal in children with bronchial asthma, and this finding is expected and reassuring rather than contradictory to the diagnosis. 1
Understanding Normal Imaging in Asthma
The correct answer is C: Between attacks, the chest X-ray is normal.
A normal chest radiograph between exacerbations is an expected finding that supports rather than contradicts the diagnosis of asthma, as stated by the British Thoracic Society guidelines. 1
The diagnosis of asthma in children is based on clinical features (especially wheezing heard by a healthcare professional on auscultation), documented response to bronchodilator therapy, and ongoing reassessment—not on chest X-ray findings. 1
In uncomplicated pediatric asthma, the airway obstruction and inflammation are reversible and resolve between attacks, so no permanent radiographic abnormalities are expected. 1
Why the Other Options Are Incorrect
Option A: Asthma Does NOT Increase Risk of Upper Respiratory Infections
Viral upper respiratory infections are common triggers that precipitate asthma exacerbations, but asthma itself does not increase a child's susceptibility to acquiring these infections. 1
The relationship is unidirectional: infections trigger asthma symptoms, but having asthma does not make children more prone to catching these infections. 1
Option B: Polyphonic Wheeze and Exertion
While exercise-induced symptoms are indeed characteristic of asthma, this statement is less informative for parents than understanding that normal imaging between attacks is expected. 2
The European Respiratory Society recommends exercise challenge testing for children with exercise-related symptoms where diagnosis cannot be confirmed with first-line tests, but this is a diagnostic consideration rather than key parental counseling information. 2
When Chest X-Rays Are Actually Indicated
The British Thoracic Society recommends chest radiographs only to rule out alternative diagnoses in children who present with atypical asthma symptoms (such as persistent wet cough, failure to thrive, or focal findings on examination). 1
During severe asthma exacerbations requiring hospitalization, chest X-rays may be obtained to exclude complications such as pneumothorax, pneumomediastinum, or pneumonia. 1
Repeat chest X-rays should be obtained only if the child develops atypical symptoms or fails to respond to appropriate asthma therapy, prompting evaluation for other conditions. 1
Clinical Pitfall to Avoid
Do not order routine chest X-rays to monitor asthma control between exacerbations—this exposes children to unnecessary ionizing radiation (with an estimated ten-fold higher lifetime cancer risk compared with adults) and provides no useful clinical information for asthma management. 1
Research shows that in hospitalized asthmatic children, only about 10% of chest X-rays led to a change in treatment plan, primarily in children who presented with fever or oxygen saturation ≤92%. 1