Real-world chest radiograph findings and clinical consequences in preschool children with recurrent wheezing

Purpose Recurrent wheezing in young children often prompts chest X-rays (CXRs) during diagnostic evaluation, despite limited evidence supporting their clinical utility. This study aimed to assess whether CXRs provide diagnostic or therapeutic benefit in children under five years of age with recurrent wheezing. Methods We conducted a retrospective review of 271 children under five years of age who presented with recurrent wheezing to a pediatric pulmonology outpatient clinic at the University Hospital of Cologne, Germany, between 2010 and 2022. All included children underwent CXR as part of their diagnostic workup. Data on clinical characteristics, CXR findings, and downstream clinical decisions were analyzed. Results Further diagnostic workup was initiated in only 1% of cases, and no changes in diagnosis or treatment were documented. Despite these limited clinical consequences, abnormal CXR findings were reported in 73% of cases. The most frequent abnormality was peribronchial cuffing (35%). Most clinical parameters—including age, sex, prematurity, and atopic conditions—were not associated with abnormal CXR findings and therefore did not identify a subgroup of children who might benefit from selective imaging. Elevated blood eosinophil counts (≥ 150/µL, p = 0.023) were the only factor associated with abnormal CXR findings. Conclusion In this real-world cohort of preschool children with recurrent wheezing, abnormal chest radiograph findings were frequent but largely nonspecific and rarely led to changes in diagnosis or clinical management. The radiographic patterns observed suggest the presence of underlying lower airway inflammation even outside of acute episodes. These findings add empirical evidence that is consistent with current recommendations advocating a clinically driven rather than routine use of chest radiography in preschool children with recurrent wheezing.