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Roehmel JF, Doerfler FJ, Koerner-Rettberg C, Brinkmann F, Schlegtendal A, Wetzke M, Rudolf I, Helms S, Große-Onnebrink J, Yu Y, Nuesslein T, Wojsyk-Banaszak I, Becker S, Eickmeier O, Sommerburg O, Omran H, Stahl M, Mall MA. Comparison of the Lung Clearance Index in Preschool Children With Primary Ciliary Dyskinesia and Cystic Fibrosis. Chest 2022; 162:534-542. [DOI: 10.1016/j.chest.2022.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/02/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
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Nielsen KG, Holgersen MG, Crowley S, Marthin JK. Chronic airway disease in primary ciliary dyskinesia—spiced with geno–phenotype associations. AMERICAN JOURNAL OF MEDICAL GENETICS PART C: SEMINARS IN MEDICAL GENETICS 2022; 190:20-35. [PMID: 35352480 PMCID: PMC9314966 DOI: 10.1002/ajmg.c.31967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 12/01/2022]
Abstract
Primary ciliary dyskinesia (PCD) can be defined as a multiorgan ciliopathy with a dominant element of chronic airway disease affecting the nose, sinuses, middle ear, and in particular, the lower airways. Although most patients with PCD are diagnosed during preschool years, it is obvious that the chronic lung disease starts its course already from birth. The many faces of the clinical picture change, as does lung function, structural lung damage, the burden of infection, and of treatment throughout life. A markedly severe neutrophil inflammation in the respiratory tract seems pervasive and is only to a minimal extent ameliorated by a treatment strategy, which is predominantly aimed at bacterial infections. An ever‐increasing understanding of the different aspects, their interrelationships, and possible different age courses conditioned by the underlying genotype is the focus of much attention. The future is likely to offer personalized medicine in the form of mRNA therapy, but to that end, it is of utmost importance that all patients with PCD be carefully characterized and given a genetic diagnosis. In this narrative review, we have concentrated on lower airways and summarized the current understanding of the chronic airway disease in this motile ciliopathy. In addition, we highlight the challenges, gaps, and opportunities in PCD lung disease research.
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Affiliation(s)
- Kim G Nielsen
- Department of Paediatrics and Adolescent Medicine Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Mathias G Holgersen
- Department of Paediatrics and Adolescent Medicine Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited Copenhagen Denmark
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases Oslo University Hospital, Rikshospitalet Oslo Norway
| | - June K Marthin
- Department of Paediatrics and Adolescent Medicine Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited Copenhagen Denmark
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Gahleitner F, Thompson J, Jackson CL, Hueppe JF, Behan L, Dehlink E, Goutaki M, Halbeisen F, Queiroz APL, Thouvenin G, Kuehni CE, Latzin P, Lucas JS, Rubbo B. Lower airway clinical outcome measures for use in primary ciliary dyskinesia research: a scoping review. ERJ Open Res 2021; 7:00320-2021. [PMID: 34853782 PMCID: PMC8628193 DOI: 10.1183/23120541.00320-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/31/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Disease-specific, well-defined and validated clinical outcome measures are essential in designing research studies. Poorly defined outcome measures hamper pooling of data and comparisons between studies. We aimed to identify and describe pulmonary outcome measures that could be used for follow-up of patients with primary ciliary dyskinesia (PCD). Methods We conducted a scoping review by systematically searching MEDLINE, Embase and the Cochrane Database of Systematic Reviews online databases for studies published from 1996 to 2020 that included ≥10 PCD adult and/or paediatric patients. Results We included 102 studies (7289 patients). 83 studies reported on spirometry, 11 on body plethysmography, 15 on multiple-breath washout, 36 on high-resolution computed tomography (HRCT), 57 on microbiology and 17 on health-related quality of life. Measurement and reporting of outcomes varied considerably between studies (e.g. different scoring systems for chest HRCT scans). Additionally, definitions of outcome measures varied (e.g. definition of chronic colonisation by respiratory pathogen), impeding direct comparisons of results. Conclusions This review highlights the need for standardisation of measurements and reporting of outcome measures to enable comparisons between studies. Defining a core set of clinical outcome measures is necessary to ensure reproducibility of results and for use in future trials and prospective cohorts.
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Affiliation(s)
- Florian Gahleitner
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Respiratory Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - James Thompson
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Claire L Jackson
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Jana F Hueppe
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Laura Behan
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Eleonora Dehlink
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Dept of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - 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 Halbeisen
- 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.,Basel Institute for Clinical Epidemiology and Biostatistics, Dept of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ana Paula L Queiroz
- School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Guillaume Thouvenin
- AP-HP, Pneumologic Unit, Trousseau Hospital, Sorbonne Universités, INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Claudia E Kuehni
- 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
| | - Philipp Latzin
- 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
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK.,School of Health Sciences, University of Southampton, Faculty of Environmental and Life Sciences, Southampton, UK
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Longitudinal Lung Volume Changes by Ultrastructure and Genotype in Primary Ciliary Dyskinesia. Ann Am Thorac Soc 2021; 18:963-970. [PMID: 33760720 DOI: 10.1513/annalsats.202007-816oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Genotype-phenotype relationships are emerging in primary ciliary dyskinesia (PCD), but little is known about lung volume changes over time. Objectives: To investigate the evolution of static lung volumes with ultrastructural defects, gene mutations, body mass index, and specific infections in PCD. Methods: Prospective, longitudinal, single-center study in children and adults evaluated twice yearly for up to 10 years. Linear mixed-effects models were used to assess associations between ciliary morphology, genetic mutations, and clinical features. Results: A total of 122 patients had 1,096 visits. At enrollment, almost all spirometric and, especially in adults, plethysmographic parameters were significantly worse in absent inner dynein arms (IDAs), central apparatus (CA) defects, and microtubular disorganization (MTD) (IDA/CA/MTD) compared with patients with normal electron microscopy (EM) results. The mean trend increase with time for residual volume (RV) was significantly higher in IDA/CA/MTD group compared with groups with outer dynein arm defect and normal EM results. The mean trend of RV/total lung capacity in the IDA/CA/MTD group was significantly worse than in all other groups. The steepest rise in lung volumes was in CCDC39 and CCDC40, whereas hyperinflation increased less in DNAH5 and DNAH11 groups. RV/total lung capacity showed a significantly steeper rise in patients with Pseudomonas aeruginosa compared with patients with other infections or patients without infection. Conclusions: Patients with IDA/CA/MTD defects or CCDC39 and CCDC40 mutations had the greatest increase in hyperinflation, whereas those with outer dynein arm defect and normal EM results or DNAH11 and DNAH5 mutations had less severe changes. We have robustly confirmed the worse prognosis for some genetic and ultrastructural defects, which association hitherto rested solely on spirometry.
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Abstract
Primary ciliary dyskinesia (PCD) is an inherited cause of bronchiectasis. The estimated PCD prevalence in children with bronchiectasis is up to 26% and in adults with bronchiectasis is 1 to 13%. Due to dysfunction of the multiple motile cilia of the respiratory tract patients suffer from poor mucociliary clearance. Clinical manifestations are heterogeneous; however, a typical patient presents with chronic productive cough and rhinosinusitis from early life. Other symptoms reflect the multiple roles of motile cilia in other organs and can include otitis media and hearing loss, infertility, situs inversus, complex congenital heart disease, and more rarely other syndromic features such as hydrocephalus and retinitis pigmentosa. Awareness, identification, and diagnosis of a patient with PCD are important for multidisciplinary care and genetic counseling. Diagnosis can be pursued through a multitest pathway which includes the measurement of nasal nitric oxide, sampling the nasal epithelium to assess ciliary function and structure, and genotyping. Diagnosis is confirmed by the identification of a hallmark ultrastructural defect or pathogenic mutations in one of > 45 PCD causing genes. When a diagnosis is established management is centered around improving mucociliary clearance through physiotherapy and treatment of infection with antibiotics. The first international randomized controlled trial in PCD has recently been conducted showing azithromycin is effective in reducing exacerbations. It is likely that evidence-based PCD-specific management guidelines and therapies will be developed in the near future. This article examines prevalence, clinical features, diagnosis, and management of PCD highlighting recent advances in basic science and clinical care.
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Affiliation(s)
- Amelia Shoemark
- Scottish Centre for Respiratory Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee DD1 9SY, United Kingdom.,PCD Diagnostic Service, Royal Brompton Hospital, London, United Kingdom
| | - Katharine Harman
- Department of Paediatrics and Child Health, King's College Hospital, London, United Kingdom
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Singer F, Schlegtendal A, Nyilas S, Vermeulen F, Boon M, Koerner-Rettberg C. Lung clearance index predicts pulmonary exacerbations in individuals with primary ciliary dyskinesia: a multicentre cohort study. Thorax 2021; 76:681-688. [PMID: 33504569 DOI: 10.1136/thoraxjnl-2020-215504] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lung clearance index (LCI) is a promising lung function outcome in individuals with primary ciliary dyskinesia (PCD). The impact of events clinically important for individuals with PCD, such as pulmonary exacerbations, on LCI is unknown. METHODS We conducted an international, multicentre, observational cohort study to assess the association of LCI and risk of pulmonary exacerbation, specific changes in LCI during pulmonary exacerbation and global variability of LCI across four visits every 4 months. Ninety individuals with PCD, aged 3-41 years, underwent nitrogen multiple-breath washout (MBW) and spirometry measurements. The association of LCI and pulmonary exacerbations was assessed by Cox proportional hazards and random-effects regression models. RESULTS We obtained 430 MBW and 427 spirometry measurements. In total, 379 person-years at risk contributed to the analysis. Per one unit increase (deterioration) in LCI, the risk of future pulmonary exacerbation increased by 13%: HR (95% CI), 1.13 (1.04 to 1.23). If LCI changed from a range of values considered normal to abnormal, the risk of future pulmonary exacerbations increased by 87%: 1.87 (1.08 to 3.23). During pulmonary exacerbations, LCI increased by 1.22 units (14.5%). After pulmonary exacerbations, LCI tended to decline. Estimates of variability in LCI suggested lower variation within individuals compared with variation between individuals. Findings were comparable for forced expiratory volume in 1 s. CONCLUSION On a visit-to-visit basis, LCI measurement may add to the prediction of pulmonary exacerbations, the assessment of lung function decline and the potential lung function response to treatment of pulmonary exacerbations.
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Affiliation(s)
- Florian Singer
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Schlegtendal
- Department of Paediatric Pulmonology, University Children's Hospital of Ruhr University Bochum at St. Josef-Hospital, Bochum, Germany
| | - Sylvia Nyilas
- Department of Diagnostic, Interventional, and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - François Vermeulen
- Paediatric Pulmonology, Department of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Mieke Boon
- Paediatric Pulmonology, Department of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Cordula Koerner-Rettberg
- Department of Paediatric Pulmonology, University Children's Hospital of Ruhr University Bochum at St. Josef-Hospital, Bochum, Germany .,Children's Hospital, Research Institute, Marien Hospital Wesel, Wesel, Germany
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Abstract
Motile cilia are highly complex hair-like organelles of epithelial cells lining the surface of various organ systems. Genetic mutations (usually with autosomal recessive inheritance) that impair ciliary beating cause a variety of motile ciliopathies, a heterogeneous group of rare disorders. The pathogenetic mechanisms, clinical symptoms and severity of the disease depend on the specific affected genes and the tissues in which they are expressed. Defects in the ependymal cilia can result in hydrocephalus, defects in the cilia in the fallopian tubes or in sperm flagella can cause female and male subfertility, respectively, and malfunctional motile monocilia of the left-right organizer during early embryonic development can lead to laterality defects such as situs inversus and heterotaxy. If mucociliary clearance in the respiratory epithelium is severely impaired, the disorder is referred to as primary ciliary dyskinesia, the most common motile ciliopathy. No single test can confirm a diagnosis of motile ciliopathy, which is based on a combination of tests including nasal nitric oxide measurement, transmission electron microscopy, immunofluorescence and genetic analyses, and high-speed video microscopy. With the exception of azithromycin, there is no evidence-based treatment for primary ciliary dyskinesia; therapies aim at relieving symptoms and reducing the effects of reduced ciliary motility.
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Kobbernagel HE, Green K, Ring AM, Buchvald FF, Rosthøj S, Gustafsson PM, Nielsen KG. One-year evolution and variability in multiple-breath washout indices in children and young adults with primary ciliary dyskinesia. Eur Clin Respir J 2019; 6:1591841. [PMID: 30949311 PMCID: PMC6442098 DOI: 10.1080/20018525.2019.1591841] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 02/27/2019] [Indexed: 11/27/2022] Open
Abstract
Background and objective: Cross-sectional and longer-term studies have demonstrated abnormal yet stable multiple-breath inert gas washout (MBW) indices in patients with primary ciliary dyskinesia (PCD). This study aimed to assess the intermediate term evolution and the between-occasion variability of MBW indices in PCD over 1 year. Methods: Children and young adults with a confirmed diagnosis of PCD were included in this single-centre, prospective, observational, longitudinal study. Over 1 year, nitrogen (N2) MBW and spirometry were performed at three occasions during ordinary scheduled outpatient visits. Trends and variability in lung clearance index (LCI), moment ratios, normalized N2 concentration at six lung volume turnovers, and regional ventilation inhomogeneity indices of the conducting and intra-acinar airways (Scond*VT and Sacin*VT) were analysed using linear mixed models. Results: Forty-two patients, aged 6–29 years (median: 15.4), performed 116 N2 MBW test occasions and 96.6% were technically acceptable. A minimal, although significant, increase in LCI over 1 year (mean: 0.51 units, 95% CI: 0.12–0.91, p = 0.01) was found; while, all other N2 MBW indices and FEV1 remained unchanged. A moderate correlation was observed between LCI and FEV1 (r = −0.47, p = 0.0001). The limits of agreement between tests 1 year apart were for LCI: −1.96 to 2.98; Scond*VT: ± 0.039; Sacin*VT: −0.108 to 0.128. Conclusions: Children and young adults with PCD managed at a specialist centre showed slightly, but significant, increasing LCI and otherwise unchanged ventilation inhomogeneity indices and dynamic volumes over the intermediate term of 1 year. Estimates of the variability of N2 MBW indices may inform sample size calculations of future randomized controlled trials.
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Affiliation(s)
- Helene Elgaard Kobbernagel
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kent Green
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Astrid Madsen Ring
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frederik Fouirnaies Buchvald
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Rosthøj
- Department of Biostatistics, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Kim Gjerum Nielsen
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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Chang AB, Bush A, Grimwood K. Bronchiectasis in children: diagnosis and treatment. Lancet 2018; 392:866-879. [PMID: 30215382 DOI: 10.1016/s0140-6736(18)31554-x] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/28/2018] [Accepted: 06/29/2018] [Indexed: 12/12/2022]
Abstract
Bronchiectasis is conventionally defined as irreversible dilatation of the bronchial tree. Bronchiectasis unrelated to cystic fibrosis is an increasingly appreciated cause of chronic respiratory-related morbidity worldwide. Few randomised controlled trials provide high-level evidence for management strategies to treat the children affected by bronchiectasis. However, both decades-old and more recent studies using technological advances support the notion that prompt diagnosis and optimal management of paediatric bronchiectasis is particularly important in early childhood. Although considered to be of a non-reversible nature, mild bronchiectasis determined by radiography might be reversible at any age if treated early, and the lung function decline associated with disease progression could then be halted. Although some management strategies are extrapolated from cystic fibrosis or adult-based studies, or both, non-cystic fibrosis paediatric-specific data to help diagnose and manage these children still need to be generated. We present current knowledge and an updated definition of bronchiectasis, and review controversies relating to the management of children with bronchiectasis, including applying the concept of so-called treatable traits.
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Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia; Department of Respiratory Medicine, Children's Health Queensland, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia.
| | - Andrew Bush
- Head of Section (Paediatrics), Imperial College London, London, UK; National Heart and Lung Institute, London, UK; Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Keith Grimwood
- Royal Brompton Harefield NHS Foundation Trust, London, UK; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Department of Infectious Diseases and Department of Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
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