Design: Prospective cross-sectional screening study
Population: 373 adolescents and adults with bronchiectasis, Shanghai registry
Primary outcome: Prevalence of PCD and accuracy of nasal nitric oxide
Effect: PCD 7.4%; nNO sensitivity 84.8%, specificity 97.1%

This cross-sectional study from a Shanghai bronchiectasis registry screened 373 adolescents and adults with nasal nitric oxide and clinical features, then gave a full diagnostic work-up — electron microscopy and whole-exome sequencing — to those with low nasal nitric oxide or strong suspicion.

Primary ciliary dyskinesia was confirmed or highly likely in 27 (7.4%). Nasal nitric oxide had a sensitivity of 84.8% and specificity of 97.1%. Patients with ciliary dyskinesia were younger at onset, had lower lung function and body mass index, and were strongly associated with rhinosinusitis (odds ratio 25.3) and Pseudomonas (8.5); a quarter had situs inversus.

Ciliary dyskinesia is under-recognised in adult bronchiectasis, and finding it changes counselling, fertility advice and family screening. Nasal nitric oxide is not widely available in India, so the clinical clues — early onset, chronic rhinosinusitis, situs inversus — are the practical first filter.

Consider primary ciliary dyskinesia in bronchiectasis that began in childhood or early adulthood.
Ask about lifelong wet cough, chronic rhinosinusitis and neonatal respiratory distress.
Check for situs inversus on chest imaging.
Refer suspected cases for nasal nitric oxide and specialist testing where available.

Why it matters

A missed diagnosis of ciliary dyskinesia affects fertility counselling and siblings, not just lung care.

The statistics, in plain English

A specificity of 97% means few false positives; a sensitivity of 85% means about one in seven cases would be missed by nasal nitric oxide alone. The very wide interval around the rhinosinusitis odds ratio (8.8 to 92.1) reflects only 27 cases.