Chest X-Ray Findings in Asthma Exacerbation and the Association with Acute Asthma Management among Children

Background: The National Heart and Lung Institute’s guidelines advise against routine use of chest X-ray (CXR) for acute asthma exacerbation. Despite this recommendation, unnecessary CXR are still being performed. The objective of this study is to assess the association between abnormal CXR findings and the severity of asthma exacerbation and its impact on acute asthma management. Methods: A retrospective chart review was performed of all pediatric patients 2-17 years of age who presented to the emergency department (ED) with acute asthma exacerbation between July 2017 and June 2019. Demographics, asthma severity, clinical parameters, and management were reviewed. Associations between severity of asthma and clinical management of patients with and without abnormal CXR findings were evaluated. Results: Total of 2691 patients presented with asthma exacerbation to the ED. A total of 197 patients in whom CXR was performed, were included; 62% were male, 56.9% were between 5-11 years of age, 39.6% had abnormal CXR and 53.3% had a mild exacerbation. There was no significant association between abnormal CXR and severity of asthma (p = 0.104). More patients with abnormal CXR were given antibiotics and had a longer length of stay (p = < 0.0001 and p = 0.02 respectively). The need for supplemental oxygen and epinephrine were higher in patients with normal CXR (p = 0.036 and p = 0.033, respectively). Conclusion: Abnormal CXR findings do not differ among patients with mild compared to moderate and severe asthma exacerbation. Those with abnormal CXR received more antibiotics and had a longer hospital stay. Further prospective studies are needed to delineate the use of CXR related to the severity of asthma exacerbation and the need for antibiotics in cases of abnormal CXR.