Design: Prospective cross-sectional screening study
Population: 373 adolescents and adults with bronchiectasis in a Shanghai registry
Primary outcome: Prevalence of PCD and accuracy of nasal NO
Effect: PCD 7.4%; nasal NO sensitivity 84.8%, specificity 97.1%

At Shanghai Pulmonary Hospital, 373 adolescents and adults with bronchiectasis from the BE-China registry were screened with nasal nitric oxide. Those with a low result (77 nL/min or less) or strong clinical suspicion had full work-up including electron microscopy and exome sequencing under 2025 ERS/ATS criteria.

Primary ciliary dyskinesia was confirmed or highly likely in 27 patients (7.4%). Nasal NO had sensitivity of 84.8% and specificity of 97.1%. Patients with PCD were younger, had earlier onset, lower lung function and BMI, and were strongly associated with chronic rhinosinusitis (OR 25.3) and Pseudomonas infection (OR 8.5). A quarter had situs inversus.

This is a single-centre study in one population, but it shows PCD is not rare in adult bronchiectasis and is easy to miss once situs inversus is absent. Nasal NO testing is not widely available in India, so clinical red flags carry more weight here.

Consider PCD in bronchiectasis that began in childhood, especially with chronic rhinosinusitis
Ask about neonatal respiratory distress, chronic wet cough since infancy and subfertility
Check for situs inversus on imaging, though most patients with PCD do not have it
Refer suspected cases to a centre with nasal NO and ciliary testing

Why it matters

A diagnosis of PCD changes airway clearance, ENT care, fertility counselling and family screening.

The statistics, in plain English

Specificity of 97.1% means few patients without PCD tested positive, which makes nasal NO a good first filter. Sensitivity of 84.8% means about one in seven cases would be missed by the test alone, hence the role of clinical suspicion.