Routine Chest X-Rays Rarely Change Management in Preschool Children With Recurrent Wheezing: Study

A new study published in the journal of BMC Pediatrics showed that even though peribronchial cuffing was the most prevalent abnormality found on 73% of chest X-rays in children under five who had recurrent wheezing, only 1% of these cases led to further diagnostic testing, and none of them changed the diagnosis or course of therapy. 

A prevalent and debilitating illness, recurrent preschool wheeze has a complicated etiology and a wide range of symptoms. Chest X-rays (CXRs) are still often utilized for diagnosis even though standards advise against it, exposing young infants to needless radiation. This study examined whether radiographic results truly change clinical therapy in afflicted children in order to assess the genuine diagnostic utility of CXRs. 

271 children under five who visited a pediatric pulmonology outpatient clinic at the University Hospital of Cologne, Germany, between 2010 and 2022 with recurrent wheezing were the subject of a retrospective study. As part of their diagnostic workup, CXR was performed on all included children. Clinical features, CXR results, and subsequent clinical choices were examined.

In just 1% of instances, additional diagnostic workup was started, and neither the diagnosis nor the course of therapy was altered. 

73% of subjects had aberrant CXR results, despite these little clinical ramifications. Peribronchial cuffing was the most common anomaly (35%). 

A subset of children who could benefit from selective imaging was not identified since the majority of clinical characteristics, such as age, sex, preterm birth, and atopic disorders, were not linked to aberrant CXR results. 

The sole factor linked to aberrant CXR results was elevated blood eosinophil counts (≥150/µL, p = 0.023).

Overall, this study offers important new information on CXR results in preschoolers who wheeze often. The clinical implications were negligible despite a high frequency of radiologic abnormalities.

In a subgroup of children, elevated blood eosinophil counts were linked to higher frequencies of radiologic abnormalities, which may indicate eosinophilic airway inflammation. Nevertheless, no reliable clinical or demographic factors were found. 

Source:

Lück, E., Jovanović, A., Ockelmann, A.-M., Reihle, A. P., Thomassen, J. C., & Körner, R. W. (2026). Real-world chest radiograph findings and clinical consequences in preschool children with recurrent wheezing. BMC Pediatrics, 26(1). https://doi.org/10.1186/s12887-026-07321-4