Understanding a rare condition that may overlap with ABPA and bronchiectasis
People living with chronic lung conditions such as asthma, bronchiectasis or ABPA (Allergic Bronchopulmonary Aspergillosis) are sometimes investigated for other underlying conditions that may help explain repeated chest infections, mucus problems or long-term lung damage. One of the rarer conditions doctors may consider is Primary Ciliary Dyskinesia (PCD).
For some patients, hearing PCD mentioned for the first time can raise many questions — especially if fertility problems are also being discussed. This article explains what PCD is, how it may relate to lung disease and Aspergillus problems, and why it can sometimes affect fertility.
Key points
- Primary Ciliary Dyskinesia (PCD) is a rare inherited condition affecting the body’s mucus-clearing system.
- It can cause recurrent chest infections, sinus problems and bronchiectasis.
- Some people with PCD may also develop fungal sensitisation or ABPA.
- Men with PCD may experience reduced fertility because sperm movement can be affected.
- PCD is often difficult to diagnose because symptoms overlap with asthma and bronchiectasis.
- Specialist testing is usually needed for diagnosis.
- Having ABPA does not automatically mean someone has PCD.
What is Primary Ciliary Dyskinesia?
Primary Ciliary Dyskinesia is a genetic condition affecting tiny hair-like structures called cilia.
These microscopic structures line parts of the body including the airways, sinuses, ears and reproductive tract. Their role is to move mucus, bacteria, dust and debris out of the lungs and airways.
In PCD, the cilia may not move properly, may move in an uncoordinated way, or may sometimes be absent altogether. As a result, mucus clearance becomes much less effective.
Why mucus clearance matters
Healthy lungs constantly produce mucus to trap particles and germs. Normally, cilia sweep this mucus upwards so it can be coughed out or swallowed.
When the system does not work properly, mucus becomes harder to clear. Bacteria and fungi may remain in the lungs for longer, repeated infections may occur, inflammation can develop, and long-term airway damage may gradually appear.
Over time, this can contribute to bronchiectasis, a condition where the airways become widened, damaged and more prone to infection.
Symptoms of PCD
Symptoms vary between individuals, but may include:
Chest and lung symptoms
- Chronic wet or productive cough
- Recurrent chest infections
- Bronchiectasis
- Wheezing
- Breathlessness
- Difficulty clearing mucus
Ear, nose and sinus symptoms
- Chronic sinusitis
- Nasal congestion
- Glue ear
- Recurrent ear infections
- Hearing problems
Other possible clues
- Symptoms beginning in childhood
- Frequent courses of antibiotics
- Persistent daily mucus production
- Situs inversus, where some internal organs are positioned differently, in some people
Not everyone with PCD has all these symptoms.
How could PCD relate to ABPA or Aspergillus?
ABPA (Allergic Bronchopulmonary Aspergillosis) develops when the immune system reacts strongly to the fungus Aspergillus fumigatus, which is common in the environment.
People with impaired mucus clearance may retain mucus for longer, have more airway inflammation, develop bronchiectasis, and potentially allow bacteria or fungi to persist more easily in the airways.
This does not mean PCD directly causes ABPA. However, chronic mucus retention and airway damage can create conditions where fungal sensitisation, colonisation or allergic responses may become more likely.
Some people investigated for difficult-to-control asthma, bronchiectasis or recurrent infections may therefore be assessed for underlying conditions such as PCD, cystic fibrosis, immune deficiency or other rare mucus-clearance disorders.
PCD and fertility
One reason PCD can be emotionally difficult to process is that it may affect fertility.
In men
Sperm movement relies on structures very similar to cilia. In some men with PCD, sperm may not move effectively, fertility may be reduced, or natural conception may become more difficult.
This does not necessarily mean infertility is absolute. Some men with PCD can still father children naturally, while others may benefit from fertility support or assisted reproductive techniques.
In women
Some women with PCD may also experience reduced fertility because cilia help move eggs through the fallopian tubes, although effects are often less severe and more variable than in men.
How is PCD diagnosed?
Diagnosing PCD can be challenging because symptoms overlap with many other respiratory conditions. Patients are often referred to specialist centres for assessment.
Testing may include:
- Nasal nitric oxide testing: people with PCD often have unusually low levels of nasal nitric oxide.
- High-speed video microscopy: this examines how cilia move under a microscope.
- Electron microscopy: this examines ciliary structure in detail.
- Genetic testing: many genes linked to PCD have now been identified.
- CT scans: doctors may look for patterns such as bronchiectasis or chronic sinus disease.
Sometimes diagnosis takes months or even years, particularly in adults whose symptoms have previously been attributed to asthma, infections or bronchiectasis alone.
Why diagnosis can be delayed
PCD is rare and its symptoms can resemble asthma, recurrent viral infections, chronic sinusitis, Chronic Obstructive Pulmonary Disease (COPD), bronchiectasis or “just bad lungs”.
Many adults diagnosed later in life report years of unexplained chest symptoms before PCD was considered.
Treatment and management
There is currently no cure for PCD itself, but treatment focuses on reducing lung damage and improving mucus clearance.
Management may include:
- Airway clearance physiotherapy
- Nebulised saline
- Prompt treatment of infections
- Exercise
- Sinus management
- Vaccinations
- Monitoring for bronchiectasis
Some patients may also require management of associated conditions such as asthma, bronchiectasis or ABPA.
Emotional impact
Being investigated for a rare condition can feel overwhelming, especially when fertility concerns are raised unexpectedly.
People may feel uncertainty, anxiety about future health, frustration over delayed diagnosis, or concern about relationships and starting a family. These reactions are understandable.
It can help to discuss concerns with respiratory specialists, fertility specialists, physiotherapists and trusted patient support organisations.
Important reassurance
- Having ABPA does not mean you have PCD.
- Fertility problems can have many different causes.
- PCD remains a relatively rare condition.
- Doctors usually investigate PCD only when a pattern of symptoms suggests it may be relevant.
Mentioning PCD as a possibility is often part of carefully exploring all possible explanations for long-term respiratory symptoms.
Questions you may wish to ask your medical team
- Why are you considering PCD?
- What features suggest it?
- What tests are planned?
- Could another condition explain my symptoms?
- Should fertility assessment be considered?
- Is referral to a specialist PCD centre needed?
When to seek medical advice
You should seek medical advice if you experience worsening breathlessness, coughing up blood, severe chest infections, unexplained weight loss, persistent fevers, or rapidly worsening mucus production.
Fertility concerns can also be discussed with your GP, respiratory specialist or fertility specialist.
Further information
References
- Lung + Asthma PCD
- PCD Support UK.
- European Respiratory Society guidelines for the diagnosis of Primary Ciliary Dyskinesia.
- NHS England. National Primary Ciliary Dyskinesia Service.
Last reviewed: May 2026
This article is for general educational purposes only and is not a substitute for personalised medical advice.
Latest News posts
News archive