Three questions about coronavirus and primary ciliary dyskinesia (PCD) – answered by Prof. Dr. Rainald Fischer

People who live with the hereditary rare disease, primary ciliary dyskinesia (PCD) are considered a high risk group in connection to the coronavirus. This genetic disorder is accompanied by periodic upper and lower airway infections. This is why many PCD patients are concerned and are afraid they might experience severe disease progression if they get COVID-19. Lung specialist Professor Dr. Rainald Fischer provides answers to their most pressing questions in an interview. The interview took place on 2 April 2020.

PARI-Blog: What specific risks are there for patients with primary ciliary dyskinesia (PCD) who become infected with the coronavirus?

Prof. Dr. Rainald Fischer: In general, for patients with primary ciliary dyskinesia who do not have severely impaired lung function, I do not think there is the risk of severe disease progression if they are infected with the coronavirus. People with PCD do not normally experience more severe disease progression with viral infections than healthy people do. The main problem for PCD is the circumstance that due to the absent or deficient cilia mucus is not removed properly, so PCD patients have more mucus in their lungs. Bacteria tend to accumulate in the mucus, while viruses do not. This is because viruses remain in the mucus for just a short time and then migrate straight into, and destroy, the cells in the airways. Basically, cilia can only remove things found in the mucus. The lack of movement of the cilia per se does not automatically lead to increased immune deficiency. Which is why people with PCD are not affected more severely due to their underlying disease and should not be at higher risk of more severe disease progression with COVID-19 than healthy people do. The risk is instead a function of each individual’ overall health.

PARI-Blog: What factors might make severe disease progression more likely with COVID-19 in PCD?

Prof. Dr. Rainald Fischer: The risk depends on the extent of the disease, in particular on the severity of bronchiectasis and lung function. Patients who already have impaired lung function, for example an FEV1 of around 50 per cent of the target value or lower may get the same problems as patients with other chronic lung diseases. This means, on the one hand, lower tolerance with respect to a drop in oxygen saturation, and on the other hand, that the inflammation in the bronchiectasis worsens. At this point I would like to mention that I am not yet aware of any cases of PCD patients infected with the coronavirus.

PARI-Blog: People with PCD often have nasal problems. Can this have any sort of negative effect on the disease progression of COVID-19?

Prof. Dr. Rainald Fischer: This is hard to say. There are no figures or data available for this. It is generally well known that PCD patients are more susceptible to bacterial infections. Bacterial infections also affect the nose and the nasal sinuses. We often see colonisation of bacterial in mucus, but this is not something viruses normally do. I have not observed that the PCD patients in my practice are more susceptible to viral infections.

PARI-Blog: Prof. Dr. Fischer, thank you very much for speaking with us.


About Prof. Dr Rainald Fischer:

Prof. Dr. Rainald Fischer is a specialist for internal medicine in private practice, with a subspecialty in lung and bronchial medicine, specialty of emergency medicine, sleep medicine and allergy medicine in Munich-Pasing. Before that he worked as an internist and lung specialist, most recently as a senior physician at the Innenstadt Munich university hospital. Prof. Dr. Rainald Fischer is a founding member and president of the German Society for Alpine and Expedition Medicine, and a member of the cystic fibrosis physicians working group.

NOTE: This interview with Prof. Dr. Fischer took place on 2 April 2020. The statements were made based on the information available at that time.

An article written by the PARI BLOG editorial team.

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