{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T06:54:35Z","timestamp":1793170475792,"version":"4.5.0"},"reference-count":41,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Nasal nitric oxide (nasal NO) measurement is the most widely used screening tool for primary ciliary dyskinesia (PCD), but its accuracy may be affected by various factors. Based on our clinical experience, we hypothesized that nasal NO values vary across seasons, being lower in winter. This study investigates seasonal nasal NO variability in subjects referred for PCD screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective study (2010-2023) analyzed 434 subjects with clinical symptoms suggestive of PCD who underwent nasal NO testing at Schneider Children\u2019s Medical Center in Israel. Of these, 105 completed multiple measurements, yielding 578 nasal NO tests available for analysis. A separate cohort of 31 subjects\u00a0diagnosed with PCD was analyzed independently. Seasons were defined based on the Mediterranean climate in Israel (according to Northern Hemisphere conventions).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 434 subjects (median age 9\u2009years, 58.5% male), median nasal NO was lower in winter (123 nL\/min) than in summer (167 nL\/min,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002), with a higher proportion of abnormal values (&lt;66 nL\/min) in winter (29.7% in January vs 6% in August,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .007). Seasonal differences were similar across age groups (below and above 5\u2009years of age). This seasonal pattern persisted throughout the observation period, though winter nasal NO variability decreased during COVID-19 pandemic lockdowns (2020\u20132022). In subjects\u00a0with PCD, nasal NO remained consistently low (median 14 nL\/min), with minimal seasonal variation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Nasal NO levels exhibited\u00a0seasonal variability, with statistically significant lower values during winter. Although most measurements remained within normal limits, there were many more abnormally low levels during winter, most of which normalized during summer. Therefore, repeat testing in another season, preferably summer, is recommended to ensure accurate PCD screening and avoid unnecessary invasive tests.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19433654251378049","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T01:20:25Z","timestamp":1759195225000},"page":"131-138","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Seasonal Variability in Nasal Nitric Oxide Measurements for Primary Ciliary Dyskinesia Screening"],"prefix":"10.1177","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6772-5784","authenticated-orcid":false,"given":"Hagit","family":"Levine","sequence":"first","affiliation":[{"name":"Drs. Levine, Tsviban, Goldberg, Dotan, Mei-Zahav, Stafler, Jacobi, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Pulmonology Institute, Schneider Children\u2019s Medical Center, Petah Tikva, Israel."},{"name":"Drs. Levine, Goldberg, Dotan, Mei-Zahav, Stafler, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4467-6217","authenticated-orcid":false,"given":"Lior","family":"Tsviban","sequence":"additional","affiliation":[{"name":"Drs. Levine, Tsviban, Goldberg, Dotan, Mei-Zahav, Stafler, Jacobi, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Pulmonology Institute, Schneider Children\u2019s Medical Center, Petah Tikva, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6725-8017","authenticated-orcid":false,"given":"Ori","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Drs. Levine, Tsviban, Goldberg, Dotan, Mei-Zahav, Stafler, Jacobi, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Pulmonology Institute, Schneider Children\u2019s Medical Center, Petah Tikva, Israel."},{"name":"Drs. Levine, Goldberg, Dotan, Mei-Zahav, Stafler, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel."},{"name":"Dr. Goldberg is affiliated with Pediatric Pulmonary Service, Kaplan Medical Centre, Rehovot and the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6308-0181","authenticated-orcid":false,"given":"Miri","family":"Dotan","sequence":"additional","affiliation":[{"name":"Drs. Levine, Tsviban, Goldberg, Dotan, Mei-Zahav, Stafler, Jacobi, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Pulmonology Institute, Schneider Children\u2019s Medical Center, Petah Tikva, Israel."},{"name":"Drs. Levine, Goldberg, Dotan, Mei-Zahav, Stafler, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6683-0264","authenticated-orcid":false,"given":"Meir","family":"Mei-Zahav","sequence":"additional","affiliation":[{"name":"Drs. Levine, Tsviban, Goldberg, Dotan, Mei-Zahav, Stafler, Jacobi, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Pulmonology Institute, Schneider Children\u2019s Medical Center, Petah Tikva, Israel."},{"name":"Drs. Levine, Goldberg, Dotan, Mei-Zahav, Stafler, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8880-8212","authenticated-orcid":false,"given":"Patrick","family":"Stafler","sequence":"additional","affiliation":[{"name":"Drs. Levine, Tsviban, Goldberg, Dotan, Mei-Zahav, Stafler, Jacobi, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Pulmonology Institute, Schneider Children\u2019s Medical Center, Petah Tikva, Israel."},{"name":"Drs. Levine, Goldberg, Dotan, Mei-Zahav, Stafler, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7286-8812","authenticated-orcid":false,"given":"Eyal","family":"Jacobi","sequence":"additional","affiliation":[{"name":"Drs. Levine, Tsviban, Goldberg, Dotan, Mei-Zahav, Stafler, Jacobi, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Pulmonology Institute, Schneider Children\u2019s Medical Center, Petah Tikva, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4955-1650","authenticated-orcid":false,"given":"Einat","family":"Shmueli","sequence":"additional","affiliation":[{"name":"Drs. Levine, Tsviban, Goldberg, Dotan, Mei-Zahav, Stafler, Jacobi, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Pulmonology Institute, Schneider Children\u2019s Medical Center, Petah Tikva, Israel."},{"name":"Drs. Levine, Goldberg, Dotan, Mei-Zahav, Stafler, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4165-0144","authenticated-orcid":false,"given":"Dario","family":"Prais","sequence":"additional","affiliation":[{"name":"Drs. Levine, Tsviban, Goldberg, Dotan, Mei-Zahav, Stafler, Jacobi, Shmueli, Prof. Prais, and Dr. Bar-On are affiliated with Pulmonology Institute, Schneider Children\u2019s Medical Center, Petah Tikva, Israel."},{"name":"Drs. 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