PURPOSE: Asthma diagnosis is based on clinical presentation. Often times a chest x-ray (CXR) is part of the initial evaluation in order to rule out other potential causes of airway obstruction, parenchymal disease, congenital anomalies or foreign bodies. Data about the sensitivity of CXRs in supporting an asthma diagnosis are scarce. Our study aimed to establish the usefulness of CXR in supporting an asthma diagnosis in pediatric patients in an outpatient setting.
METHODS: Medical records of children 1 to 18 years of age were identified with diagnoses of either persistent cough or asthma at the initial visit. Patients who subsequently underwent a CXR were selected for analysis. CXR reports were categorized as normal, suggestive of asthma, or as having other incidental findings. Subsequent visits of patients diagnosed with persistent cough were further evaluated to identify those diagnosed with asthma on follow up. We also collected, when available, results of spirometry testing.
RESULTS: Of 179 records analyzed, 90 had an initial diagnosis of asthma and 89 had persistent cough. 30% (n=27) of children diagnosed with asthma and 18% (n=16) diagnosed with persistent cough had CXR findings suggestive of asthma (p=0.0133). The mean age of children with CXR findings suggestive of asthma was 5.2 years compared to 8.6 years for those with negative findings (p< 0.0001). Only one patient diagnosed with asthma had both CXR and spirometry findings suggestive of asthma. 28% (n=25) of patients diagnosed with persistent cough were subsequently diagnosed with asthma. Of those, 32% (n=8) had CXR findings suggestive of asthma.
CONCLUSION: 30% of patients initially diagnosed with asthma had CXR findings suggestive of asthma. This prevalence was maintained when patients with the more general diagnosis of persistent cough were subsequently found to have asthma. Spirometry was neither superior nor inferior to CXR in supporting the diagnosis.
CLINICAL IMPLICATIONS: Baseline CXR supports an asthma diagnosis in approximately 30% of pediatric patients, more so in younger children.
DISCLOSURE: Claudia Halaby, No Financial Disclosure Information; No Product/Research Disclosure Information