{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T05:43:54Z","timestamp":1771652634167,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      When monitoring lung function in patients with Cystic Fibrosis (pwCF) and Primary Ciliary Dyskinesia (pwPCD), nitrogen multiple breath washout (N\n                      <jats:sub>2<\/jats:sub>\n                      MBW) is usually performed before spirometry to prevent forced expiratory maneuvers from altering N\n                      <jats:sub>2<\/jats:sub>\n                      MBW results. The N\n                      <jats:sub>2<\/jats:sub>\n                      MBW may affect spirometry if cooperation decreases after a long period of examination or due to prolonged oxygen inhalation. The equivalence of these concepts has never been investigated in a randomized cross\u2010over trial. We hypothesized that the order of pulmonary function tests (PFTs) would not influence the\n                      <jats:italic>z<\/jats:italic>\n                      \u2010score FEV\n                      <jats:sub>1<\/jats:sub>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 47 clinically stable outpatients (36 pwCF, 11 pwPCD; 16.7\u2009\u00b1\u20098.1 years) were randomized into two groups. Each patient underwent N\n                      <jats:sub>2<\/jats:sub>\n                      MBW and spirometry at two consecutive visits (median interval 104 days): Group I: Spirometry followed by N\n                      <jats:sub>2<\/jats:sub>\n                      MBW (A), reversed order at the second visit (B), Group II reversed (B\u2192A).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Statistics<\/jats:title>\n                    <jats:p>\n                      For the equivalence test, a change in\n                      <jats:italic>z<\/jats:italic>\n                      \u2010score FEV1 (primary endpoint) \u00b10.2 and lung clearance index (LCI\n                      <jats:sub>2.5<\/jats:sub>\n                      , secondary endpoint) \u00b115% was not considered relevant; therefore, changes outside this range were considered an intervention effect in the linear mixed model (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There was a significant deterioration in\n                      <jats:italic>z<\/jats:italic>\n                      \u2010score FEV1 between the two appointments (period effect: \u22120.177;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012). The intervention effect and 95% confidence interval were within the equivalence range in both groups (\n                      <jats:italic>z<\/jats:italic>\n                      \u2010score FEV1: 0.039; \u22120.0765 to 0.1539, LCI\n                      <jats:sub>2.5<\/jats:sub>\n                      : \u22120.082; \u22120.3691 to 0.2054).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In our cohort the order of PFTs has no influence on the results suggesting that a greater flexibility in practice is possible without the risk of falsifying results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>German Clinical Trials Register (No. DRKS00027473).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71189","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T12:40:41Z","timestamp":1752151241000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Randomized Cross\u2010Over Analysis of the Influence of Nitrogen Multiple Breath Washout on Spirometry in Monitoring Lung Function in Patients With Cystic Fibrosis and Primary Ciliary Dyskinesia"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8698-8058","authenticated-orcid":false,"given":"Anna Charlotte","family":"Schoop","sequence":"first","affiliation":[{"name":"Department of Paediatric Pneumology University Children's Hospital, Katholisches Klinikum Bochum, Ruhr\u2010University Bochum Bochum Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"Denz","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology Ruhr\u2010University Bochum Bochum Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Maier","sequence":"additional","affiliation":[{"name":"University Children's Hospital, Katholisches Klinikum Bochum, Ruhr\u2010University Bochum Bochum Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Folke","family":"Brinkmann","sequence":"additional","affiliation":[{"name":"University Medical Center Schleswig\u2010Holstein, Campus Centrum L\u00fcbeck, The University of L\u00fcbeck L\u00fcbeck Germany"},{"name":"Airway Research Center North (ARCN) of the German Center of Lung Research (DZL) Grosshansdorf Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"L\u00fccke","sequence":"additional","affiliation":[{"name":"University Children's Hospital, Katholisches Klinikum Bochum, Ruhr\u2010University Bochum Bochum 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