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Affiliation(s)
- Özge Yılmaz
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Metin Akgün
- Editor in Chief.,Department of Chest Diseases, Atatürk University School of Medicine, Erzurum, Turkey
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52
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Goutaki M, Halbeisen FS, Spycher BD, Maurer E, Belle F, Amirav I, Behan L, Boon M, Carr S, Casaulta C, Clement A, Crowley S, Dell S, Ferkol T, Haarman EG, Karadag B, Knowles M, Koerner-Rettberg C, Leigh MW, Loebinger MR, Mazurek H, Morgan L, Nielsen KG, Phillipsen M, Sagel SD, Santamaria F, Schwerk N, Yiallouros P, Lucas JS, Kuehni CE. Growth and nutritional status, and their association with lung function: a study from the international Primary Ciliary Dyskinesia Cohort. Eur Respir J 2017; 50:50/6/1701659. [PMID: 29269581 DOI: 10.1183/13993003.01659-2017] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/15/2017] [Indexed: 01/02/2023]
Abstract
Chronic respiratory disease can affect growth and nutrition, which can influence lung function. We investigated height, body mass index (BMI), and lung function in patients with primary ciliary dyskinesia (PCD).In this study, based on the international PCD (iPCD) Cohort, we calculated z-scores for height and BMI using World Health Organization (WHO) and national growth references, and assessed associations with age, sex, country, diagnostic certainty, age at diagnosis, organ laterality and lung function in multilevel regression models that accounted for repeated measurements.We analysed 6402 measurements from 1609 iPCD Cohort patients. Height was reduced compared to WHO (z-score -0.12, 95% CI -0.17 to -0.06) and national references (z-score -0.27, 95% CI -0.33 to -0.21) in male and female patients in all age groups, with variation between countries. Height and BMI were higher in patients diagnosed earlier in life (p=0.026 and p<0.001, respectively) and closely associated with forced expiratory volume in 1 s and forced vital capacity z-scores (p<0.001).Our study indicates that both growth and nutrition are affected adversely in PCD patients from early life and are both strongly associated with lung function. If supported by longitudinal studies, these findings suggest that early diagnosis with multidisciplinary management and nutritional advice could improve growth and delay disease progression and lung function impairment in PCD.
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Affiliation(s)
- Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Florian S Halbeisen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elisabeth Maurer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Fabiën Belle
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Laura Behan
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK.,School of Applied Psychology, University College Cork, Cork, Ireland
| | - Mieke Boon
- Dept of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Siobhan Carr
- Primary Ciliary Dyskinesia Centre, Dept of Paediatrics, Royal Brompton and Harefield Foundation Trust, London, UK
| | | | | | - Suzanne Crowley
- Unit for Paediatric Heart, Lung, Allergic Diseases, Rikshospitalet, Oslo, Norway
| | - Sharon Dell
- Dept of Pediatrics, SickKids Hospital, University of Toronto, Toronto, Canada
| | - Thomas Ferkol
- Dept of Pediatrics, School of Medicine, Washington University, St Louis, MO, USA
| | - Eric G Haarman
- Dept of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bulent Karadag
- Dept of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Michael Knowles
- Dept of Medicine, Marsico Lung Institute, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Margaret W Leigh
- Dept of Pediatrics, Marsico Lung Institute, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Michael R Loebinger
- Host Defence Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Henryk Mazurek
- Dept of Pneumonology and Cystic Fibrosis, Institute of Tuberculosis and Lung Disorders, Rabka-Zdrój, Poland
| | - Lucy Morgan
- Dept of Respiratory Medicine, Concord Hospital Clinical School, University of Sydney, Sydney, Australia
| | - Kim G Nielsen
- Danish PCD Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Phillipsen
- Danish PCD Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen University Hospital, Copenhagen, Denmark
| | - Scott D Sagel
- Dept of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Nicolaus Schwerk
- Clinic for Paediatric Pulmonology, Allergiology and Neonatology, Hannover Medical School, Hannover, Germany
| | | | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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53
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Dixon M, Shoemark A. Secondary defects detected by transmission electron microscopy in primary ciliary dyskinesia diagnostics. Ultrastruct Pathol 2017; 41:390-398. [PMID: 28922056 DOI: 10.1080/01913123.2017.1365990] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary ciliary dyskinesia (PCD) is predominantly an autosomal recessively inherited condition that affects ~1 in 15,000 people. Diagnosis of PCD can be complex and is ordinarily based on the results of multiple investigations. These investigations include nasal nitric oxide, high-speed video microscopy, genotyping, and electron microscopy analysis of ciliary ultrastructure. A diagnosis is ultimately confirmed by the presence of a hallmark defect identified by transmission electron microscopy or biallelic variants in a known PCD gene. Secondary ciliary defects are commonly seen in samples submitted for diagnosis of PCD. Acquired secondary ciliary ultrastructural abnormalities, which are not caused by a variant in a ciliary gene, are usually transient and reversible however failure to separate primary versus secondary defects can lead to misdiagnosis. In this review, we describe causes of secondary ciliary defects, identify the ultrastructural appearances associated with secondary ciliary dyskinesia and finally suggest methods to avoid misdiagnosis of PCD due to these acquired ciliary defects.
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Affiliation(s)
- Mellisa Dixon
- a Department of Paediatrics , Royal Brompton Hospital , London , United Kingdom
| | - Amelia Shoemark
- a Department of Paediatrics , Royal Brompton Hospital , London , United Kingdom.,b School of Medicine , University of Dundee, Ninewells Hospital and Medical School , Dundee , United Kingdom
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54
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Rubbo B, Lucas JS. Clinical care for primary ciliary dyskinesia: current challenges and future directions. Eur Respir Rev 2017; 26:26/145/170023. [PMID: 28877972 PMCID: PMC9489029 DOI: 10.1183/16000617.0023-2017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/13/2017] [Indexed: 12/14/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disease that affects the motility of cilia, leading to impaired mucociliary clearance. It is estimated that the vast majority of patients with PCD have not been diagnosed as such, providing a major obstacle to delivering appropriate care. Challenges in diagnosing PCD include lack of disease-specific symptoms and absence of a single, “gold standard”, diagnostic test. Management of patients is currently not based on high-level evidence because research findings are mostly derived from small observational studies with limited follow-up period. In this review, we provide a critical overview of the available literature on clinical care for PCD patients, including recent advances. We identify barriers to PCD research and make suggestions for overcoming challenges. Challenges in PCD must be overcome through international collaboration; networks must build on recent advanceshttp://ow.ly/4d4I30dXzWg
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Affiliation(s)
- Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University of Southampton, Southampton, UK.,Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University of Southampton, Southampton, UK .,Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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55
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Chalmers JD, Crichton M, Goeminne PC, Loebinger MR, Haworth C, Almagro M, Vendrell M, De Soyza A, Dhar R, Morgan L, Blasi F, Aliberti S, Boyd J, Polverino E. The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC): experiences from a successful ERS Clinical Research Collaboration. Breathe (Sheff) 2017; 13:180-192. [PMID: 28894479 PMCID: PMC5584712 DOI: 10.1183/20734735.005117] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In contrast to airway diseases like chronic obstructive pulmonary disease or asthma, and rare diseases such as cystic fibrosis, there has been little research and few clinical trials in bronchiectasis. Guidelines are primarily based on expert opinion and treatment is challenging because of the heterogeneous nature of the disease. In an effort to address decades of underinvestment in bronchiectasis research, education and clinical care, the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) was established in 2012 as a collaborative pan-European network to bring together bronchiectasis researchers. The European Respiratory Society officially funded EMBARC in 2013 as a Clinical Research Collaboration, providing support and infrastructure to allow the project to grow. EMBARC has now established an international bronchiectasis registry that is active in more than 30 countries both within and outside Europe. Beyond the registry, the network participates in designing and facilitating clinical trials, has set international research priorities, promotes education and has participated in producing the first international bronchiectasis guidelines. This manuscript article the development, structure and achievements of EMBARC from 2012 to 2017. EDUCATIONAL AIMS To understand the role of Clinical Research Collaborations as the major way in which the European Respiratory Society can stimulate clinical research in different disease areasTo understand some of the key features of successful disease registriesTo review key epidemiological, clinical and translational studies of bronchiectasis contributed by the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) project in the past 5 yearsTo understand the key research priorities identified by EMBARC for the next 5 years.
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Affiliation(s)
- James D. Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Megan Crichton
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | | | | | - Montse Vendrell
- Bronchiectasis Research Group, Dr Trueta University Hospital, Girona, Spain
| | | | - Raja Dhar
- Dept of Respiratory Medicine, Fortis Hospital, Kolkata, India
| | - Lucy Morgan
- Dept of Respiratory Medicine, Concord Hospital, Concord Clinical School, University of Sydney, Sydney, Australia
| | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, University of Milan, Cardio-Thoracic Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Aliberti
- Dept of Pathophysiology and Transplantation, University of Milan, Cardio-Thoracic Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Eva Polverino
- Servei de Pneumologia, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron, Barcelona, Spain
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Kuehni CE, Lucas JS. Diagnosis of primary ciliary dyskinesia: summary of the ERS Task Force report. Breathe (Sheff) 2017; 13:166-178. [PMID: 28894478 PMCID: PMC5584715 DOI: 10.1183/20734735.008517] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Key points Primary ciliary dyskinesia (PCD) is a genetically and clinically heterogeneous disease characterised by abnormal motile ciliary function. There is no “gold standard” diagnostic test for PCD. The European Respiratory Society (ERS) Task Force Guidelines for diagnosing PCD recommend that patients should be referred for diagnostic testing if they have several of the following features: persistent wet cough; situs anomalies; congenital cardiac defects; persistent rhinitis; chronic middle ear disease with or without hearing loss; or a history, in term infants, of neonatal upper and lower respiratory symptoms or neonatal intensive care admission. The ERS Task Force recommends that patients should be investigated in a specialist PCD centre with access to a range of complementary tests: nasal nitric oxide, high-speed video microscopy analysis and transmission electron microscopy. Additional tests including immunofluorescence labelling of ciliary proteins and genetic testing may also help determine the diagnosis.
Educational aims This article is intended for primary and secondary care physicians interested in primary ciliary dyskinesia (PCD), i.e. those who identify patients for testing, and those involved in diagnosing and managing PCD patients. It aims:
to inform readers about the new European Respiratory Society Task Force Guidelines for diagnosing patients with PCD to enable primary and secondary care physicians to: identify patients who need diagnostic testing; understand the diagnostic tests that their patients will undergo, the results of the tests and their limitations; and ensure that appropriate care is subsequently delivered.
What primary and secondary care physicians should know about the diagnosis of primary ciliary dyskinesiahttp://ow.ly/obix30drts1
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Affiliation(s)
- Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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57
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Lucas JS, Alanin MC, Collins S, Harris A, Johansen HK, Nielsen KG, Papon JF, Robinson P, Walker WT. Clinical care of children with primary ciliary dyskinesia. Expert Rev Respir Med 2017; 11:779-790. [DOI: 10.1080/17476348.2017.1360770] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Jane S. Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton, Southampton, United Kingdom
| | - Mikkel Christian Alanin
- Department of Otorhinolaryngology – Head and Neck Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Samuel Collins
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton, Southampton, United Kingdom
| | - Amanda Harris
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton, Southampton, United Kingdom
| | - Helle Krogh Johansen
- Department of Clinical Microbiology, Afsnit 9301, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim G Nielsen
- Danish PCD & chILD Centre, CF Centre Copenhagen Paediatric Pulmonary Service, ERN Accredited for PCD and CF Health Care, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jean Francois Papon
- APHP, Bicetre University Hospital, ENT Department, Universite Paris-Sud, Faculté de Médecine, Le Kremlin-Bicetre, France
| | - Phil Robinson
- PCD Service, Department of Respiratory and Sleep Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Woolf T. Walker
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton, Southampton, United Kingdom
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58
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Goutaki M, Halbeisen FS, Kuehni CE. The time is right for an international PCD disease registry: insight and ongoing research activities. Eur Respir J 2017; 49:49/6/1700357. [PMID: 28596427 DOI: 10.1183/13993003.00357-2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/05/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland .,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Florian S Halbeisen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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59
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Kuehni CE, Goutaki M, Kobbernagel HE. Hypertonic saline in patients with primary ciliary dyskinesia: on the road to evidence-based treatment for a rare lung disease. Eur Respir J 2017; 49:49/2/1602514. [DOI: 10.1183/13993003.02514-2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 12/21/2022]
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60
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Haver K. The time is right for an international primary ciliary dyskinesia disease registry. Eur Respir J 2017; 49:49/1/1602143. [PMID: 28052961 DOI: 10.1183/13993003.02143-2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/08/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Kenan Haver
- Harvard Medical School, Boston, MA, USA .,Division of Respiratory Diseases, Children's Hospital Boston, Boston, MA, USA
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61
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Rubbo B, Behan L, Dehlink E, Goutaki M, Hogg C, Kouis P, Kuehni CE, Latzin P, Nielsen K, Norris D, Nyilas S, Price M, Lucas JS. Proceedings of the COST action BM1407 inaugural conference BEAT-PCD: translational research in primary ciliary dyskinesia - bench, bedside, and population perspectives. BMC Proc 2016; 10:66. [PMID: 28813544 PMCID: PMC5260785 DOI: 10.1186/s12919-016-0067-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare heterogenous condition that causes progressive suppurative lung disease, chronic rhinosinusitis, chronic otitis media, infertility and abnormal situs. 'Better Experimental Approaches to Treat Primary Ciliary Dyskinesia' (BEAT-PCD) is a network of scientists and clinicians coordinating research from basic science through to clinical care with the intention of developing treatments and diagnostics that lead to improved long-term outcomes for patients. BEAT-PCD activities are supported by EU Framework Programme Horizon 2020 funded COST Action (BM1407). The Inaugural Conference of BEAT-PCD was held in December 2015 in Southampton, UK. The conference attracted ninety-six scientists, clinicians, allied health professionals, industrial partners and patient representatives from twenty countries. We aimed to identify the needs for PCD research and clinical care, particularly focussing on basic science, epidemiology, diagnostic testing, clinical management and clinical trials. The multidisciplinary conference provided an interactive platform for exchanging ideas through a program of lectures, poster presentations, breakout sessions and workshops. This allowed us to develop plans for collaborative studies. In this report, we summarize the meeting, highlight developments, and discuss open questions thereby documenting ongoing developments in the field of PCD research.
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Affiliation(s)
- Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Laura Behan
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Eleonora Dehlink
- Primary Ciliary Dyskinesia Centre, Department of Paediatrics, Royal Brompton and Harefield Foundation Trust, London, UK
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children’s University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claire Hogg
- Primary Ciliary Dyskinesia Centre, Department of Paediatrics, Royal Brompton and Harefield Foundation Trust, London, UK
| | - Panayiotis Kouis
- Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- Paediatric Respiratory Medicine, Children’s University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Kim Nielsen
- Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Sylvia Nyilas
- Paediatric Respiratory Medicine, Children’s University Hospital of Bern, University of Bern, Bern, Switzerland
- Department of Paediatric Pulmonology, University Children’s Hospital Basel (UKBB), Basel, Switzerland
| | - Mareike Price
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Jane S. Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
- Faculty of Medicine Mail Point 803, University Hospital Southampton, Southampton, SO16 6YD UK
| | - on behalf of BEAT-PCD
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
- Primary Ciliary Dyskinesia Centre, Department of Paediatrics, Royal Brompton and Harefield Foundation Trust, London, UK
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children’s University Hospital of Bern, University of Bern, Bern, Switzerland
- Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
- Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
- MRC Harwell, Harwell Campus, Oxfordshire, UK
- Department of Paediatric Pulmonology, University Children’s Hospital Basel (UKBB), Basel, Switzerland
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
- Faculty of Medicine Mail Point 803, University Hospital Southampton, Southampton, SO16 6YD UK
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