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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: 5] [Impact Index Per Article: 1.3] [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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Brennan SK, Molter D, Menezes M, Dunsky K, Leonard D, Lieu J, Hirose K, Hazan G, Horani A, Ferkol T, Brody SL. Implementation of a screening tool for primary ciliary dyskinesia (PCD) in a pediatric otolaryngology clinic. Int J Pediatr Otorhinolaryngol 2021; 142:110586. [PMID: 33388601 PMCID: PMC8021076 DOI: 10.1016/j.ijporl.2020.110586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare genetic disease arising from motile ciliary dysfunction and associated with recurrent and chronic upper and lower respiratory tract infections. Pediatric otolaryngologists may see these patients prior to the development of lung disease. Features of PCD may overlap with other suppurative respiratory diseases, creating diagnostic challenges. A simple screening tool would be beneficial to identify potential patients who have chronic upper respiratory tract disease requiring further specialist evaluation. OBJECTIVE To test a simple screening tool consisting of four questions to detect PCD in children with chronic otitis media and chronic rhinosinusitis seen in a tertiary otolaryngology clinic. METHODS A prospective, single site, observational study in a tertiary care pediatric otolaryngology clinic. Children aged 3-17 years diagnosed with chronic otitis media or rhinosinusitis with onset at less than 2 years of age were recruited. All study subjects had at least one of four key clinical features for PCD as determined by answers to screening questions, while control subjects had none. All participants completed a medical history questionnaire and nasal nitric oxide measurements. Those with reduced nasal nitric oxide levels were referred to our PCD center for further evaluation. RESULTS A total of 153 patients were screened and 62 subjects were enrolled. Of those, 35 were enrolled as study subjects and 27 as matched controls. Study subjects had mean age of 7.5 years (3.2-16.5) with pre-screening diagnosis of chronic otitis media (n = 29) or chronic rhinosinusitis (n = 6). Control subjects (n = 27) had mean age 7.2 years (3.0-16.3) with pre-screening diagnosis of chronic otitis media (n = 25), and chronic rhinosinusitis (n = 2). There were no differences in subject demographics or mean nasal nitric oxide values between the two groups (179.8 vs 210.8 nl/min). Ten individuals had low nasal nitric oxide values, 7 of which were normal on repeat testing. Three subjects failed to return for follow up evaluations. Four referrals were made for further evaluation on the basis of clinical symptoms and nasal nitric oxide results. While no new cases of PCD were detected, a subject and his sibling with recurrent sinopulmonary infections were referred for immunologic evaluation. CONCLUSION The use of standardized screening questions can be used in an otolaryngology clinic to identify patients who require further evaluation for PCD or primary immunodeficiency.
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Affiliation(s)
- Steven K Brennan
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116 St Louis, MO 63110, USA.
| | - David Molter
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115 St Louis, MO 63110, USA
| | - Maithilee Menezes
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115 St Louis, MO 63110, USA
| | - Katherine Dunsky
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115 St Louis, MO 63110, USA
| | - David Leonard
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115 St Louis, MO 63110, USA
| | - Judith Lieu
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115 St Louis, MO 63110, USA
| | - Keiko Hirose
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115 St Louis, MO 63110, USA
| | - Guy Hazan
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116 St Louis, MO 63110, USA
| | - Amjad Horani
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116 St Louis, MO 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8228 St Louis, MO 63110, USA
| | - Thomas Ferkol
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116 St Louis, MO 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8228 St Louis, MO 63110, USA
| | - Steven L Brody
- Department of Medicine, Division of Pulmonary and Critical Care, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052 St Louis, MO 63110, USA
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Amirav I, Roduta Roberts M, Mussaffi H, Mandelberg A, Roth Y, Abitbul R, Luder A, Blau H, Alkrinawi S, Aviram M, Ben-Ami M, Rotschild M, Bentur L, Shoseyov D, Cohen-Cymberknoh M, Kerem E, Avital A, Springer C, Hevroni A, Dabbah H, Elizur A, Picard E, Goldberg S, Rivlin J, Livnat G, Lavie M, Alias N, Soferman R, Olbrich H, Raidt J, Wallmeier J, Werner C, Loges NT, Omran H. Collecting clinical data in primary ciliary dyskinesia- challenges and opportunities. F1000Res 2016; 5:2031. [PMID: 27781089 PMCID: PMC5022703 DOI: 10.12688/f1000research.9323.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 11/20/2022] Open
Abstract
Rationale: Primary ciliary dyskinesia (PCD) is under diagnosed and underestimated. Most clinical research has used some form of questionnaires to capture data but none has been critically evaluated particularly with respect to its end-user feasibility and utility. Objective: To critically appraise a clinical data collection questionnaire for PCD used in a large national PCD consortium in order to apply conclusions in future PCD research. Methods: We describe the development, validation and revision process of a clinical questionnaire for PCD and its evaluation during a national clinical PCD study with respect to data collection and analysis, initial completion rates and user feedback. Results: 14 centers participating in the consortium successfully completed the revised version of the questionnaire for 173 patients with various completion rates for various items. While content and internal consistency analysis demonstrated validity, there were methodological deficiencies impacting completion rates and end-user utility. These deficiencies were addressed resulting in a more valid questionnaire. Conclusions: Our experience may be useful for future clinical research in PCD. Based on the feedback collected on the questionnaire through analysis of completion rates, judgmental analysis of the content, and feedback from experts and end users, we suggest a practicable framework for development of similar tools for various future PCD research.
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Affiliation(s)
- Israel Amirav
- Department of Pediatrics, University of Alberta, Edmonton, Canada; Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Huda Mussaffi
- Schneider Children's Medical Center of Israel, Tel Aviv, Israel
| | | | - Yehudah Roth
- The Edith Wolfson Medical Center, Tel Aviv University, Holon, Israel
| | - Revital Abitbul
- Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Anthony Luder
- Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hannah Blau
- Schneider Children's Medical Center of Israel, Tel Aviv, Israel
| | | | | | - Marta Ben-Ami
- Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | | | - David Shoseyov
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | | | - Eitan Kerem
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Avraham Avital
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Chaim Springer
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Avigdor Hevroni
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Husein Dabbah
- Galilee Medical Center, Naharia, Bar Ilan Faculty of Medicine, Safed, Israel
| | | | - Elie Picard
- Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | | | - Moran Lavie
- Sheba Medical Center , Tel Aviv University, Tel Aviv, Israel
| | | | | | - Heike Olbrich
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Johanna Raidt
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Julia Wallmeier
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Claudius Werner
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Niki T Loges
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Heymut Omran
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
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