Wednesday 1 July, 2026 | Read time: 6 mins
Beth Wright
With an unknown cause in nearly 1/3 of patients (20-40%) [1], bronchiectasis remains one of the biggest question marks in respiratory disease (as though this disease group needed more [2]).
The challenges underlying the diagnosis, treatment and mechanism continue to prevail with the undeniable heterogeneity of the disease. With genetic and environmental factors playing major roles in the development of bronchiectasis, its clinical and biological complexity is profound [3].
So, for World Bronchiectasis Day today, let's start with the basics before uncovering the exciting breakthroughs, possibilities and roadblocks.
What's actually going on in the lungs?
Bronchiectasis happens when the airways widen because of long-term inflammation or infection [1]. That widening is permanent, the damage doesn't just reverse overnight like the redness of a papercut might, and it lets mucus pool in places it definitely shouldn't.
Once mucus sits there, it becomes the perfect breeding ground for bacteria [3], which drives more infection, which drives more inflammation, which causes more damage etc.
It's a positive-feedback loop, and once someone is in it, the disease may worsen by feeding itself.
It can show up in a single patch of lung or spread across both, and it's marked by repeated flare-ups (known as exacerbations), which are like chest infections that come back again and again [3].
The Zebra of Respiratory Disease - revealing bronchiectasis’ true diversity
Bronchiectasis can be congenital (present from birth due to lung development in utero) or, far more commonly, acquired over time.
There are many reason for acquiring bronchiectasis. It can be the result of repeated or severe lung infections like pneumonia, whooping cough, or tuberculosis, especially if they happened in childhood.
It affects people of all ages and research indicates that frequency increases in women, older adults, and certain ethnic groups, including Aboriginal and Torres Strait Islander peoples (although the true burden amongst First Nations populations is very likely to be underestimated [4]).
A number of underlying conditions raise the risk, including:
- Cystic fibrosis, which is responsible for close to half of U.S. cases
- Immune deficiencies, such as common variable immunodeficiency (CVID) and, less commonly, HIV
- Allergic bronchopulmonary aspergillosis, an allergic reaction to the fungus Aspergillus
- Primary ciliary dyskinesia and other conditions affecting the tiny hair-like cilia that normally sweep mucus out of the airways
- Chronic aspiration, where food or fluid repeatedly enters the lungs
- Connective tissue diseases like rheumatoid arthritis, Sjögren's syndrome, and Crohn's disease
It also travels in company. In kids, it frequently overlaps with cystic fibrosis and primary ciliary dyskinesia. In adults, it shows up alongside immune conditions, severe COPD, and severe asthma. Left unmanaged, it can escalate to respiratory failure, collapsed lung, or heart failure, which is exactly why early, consistent management matters so much.
Same disease, different inflammatory response: Why patients with bronchiectasis do not have the same type of inflammation
Although the majority of patients may have neutrophil-driven inflammation, around 20% have eosinophil-driven inflammation instead, which is surprisingly closer to what you'd see in some asthma patients.
For that group, drugs like benralizumab (already used in eosinophilic asthma) are showing early promise.
It's a reminder that "bronchiectasis" is really an umbrella term for several different underlying processes.
Living with it: what treatment looks like today
There is currently no cure for bronchiectasis, but the condition can be managed with ongoing treatment and regular monitoring. Management typically focuses on reducing symptoms, preventing flare-ups, and slowing disease progression, as exacerbations can have a significant impact on symptoms and quality of life.
Current management typically includes:
- Airway clearance involves daily physiotherapy-guided routines (breathing techniques, positive expiratory pressure devices, nebulised saline) to physically shift mucus out before it causes trouble
- Ongoing antibiotic treatments can be oral, inhaled, or IV, and mainly used during flare-ups, with long-term low-dose courses sometimes prescribed for patients with frequent exacerbations
- Oxygen therapy for the subset of patients with low blood oxygen, either continuously or just during activity
- Pulmonary rehabilitation is another important consideration involving structured exercise and education to build capacity and reduce exacerbation risks
- Healthy lifestyle habits, and emotional support are also important considerations as anxiety and depression are common companions to a chronic lung condition, and they deserve just as much attention as the physical symptoms
The incredible research being undertaken to clear the air around bronchiectasis
Bronchiectasis has been chronically under-researched compared to conditions like COPD or asthma, but that's shifting.
The increased awareness, thanks to programs like World Bronchiectasis Day, has increased diagnosis and understanding, and although the prevalence may have similarly seen a rise as a result, it reflects an overall positive trend [4].
A recent review in Frontiers, "Therapies for bronchiectasis: mechanisms and potential effects" by Yu, Zhu, Jin, Ding and Jin, maps out where the drug pipeline actually stands, and it's more active than a lot of patients (or even clinicians) might realise [5].
Where we stand on the treatment front of Bronchiectasis
No cure yet, and no single breakthrough drug that changes everything overnight.
But there is real momentum: a maturing drug pipeline, more precise biomarkers, and (maybe most importantly) a research community that's finally treating bronchiectasis's messiness as the central problem to solve, rather than an inconvenience to work around.
The drugs being designed for bronchiectasis
The furthest-along candidate for treating bronchiectasis is Brensocatib (sold under the brand name Brinsupri), an oral DPP-1 (cathepsin C) inhibitor. Instead of attacking bacteria or opening the airways, it works upstream, dialling down the immune cells ‘neutrophils’ that drive much of the ongoing lung damage [6].
Its Phase 3 ASPEN trial, published in the New England Journal of Medicine in 2025, found it meaningfully reduced how often people flared up and slowed the rate of lung function decline compared with placebo [7].
Not to mention that a few other drugs in the same class (including BI 1291583 and HSK31858) are moving through trials right behind it.
Can Bronchiectasis be prevented?
Not entirely, and that's important to say plainly.
Since so much of acquired bronchiectasis traces back to infection and lung damage, prevention really means reducing your risk, not eliminating it. You cannot simply choose not to get a lung infection, and plenty of people who take every precaution below still develop bronchiectasis [8,9].
What you can do is stack the odds in your favour:
- Staying current on childhood vaccines (measles, whooping cough)
- Getting flu, pneumonia, and COVID-19 vaccines
- Avoiding smoke, fumes, and other lung irritants
- Treating childhood lung infections promptly
- Keeping a close eye on small children around small objects that could be inhaled
The big research takeaway
Bronchiectasis needs to stop being treated as a single disease.
Researchers argue the field's next step is sorting patients by biomarker and phenotype, treating the eosinophilic patient differently from the neutrophil-dominant one, and the infection-driven case differently from the structural-damage-driven one, rather than testing one drug against "bronchiectasis" as if it were one thing.
For today, on World Bronchiectasis Day, that's worth marking.
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References
- Perea L, Faner R, Chalmers J, et al. Pathophysiology and genomics of bronchiectasis. European Respiratory Review 2024;33(173):240055. https://doi.org/10.1183/16000617.0055-2024
- Santoni, A., Wait, S., van Boven, J. F. M., Desson, Z., Jenkins, C., Khoo, E. M., Winders, T., Yang, D., & Yorgancioglu, A. (2025). Improving Care for People with Chronic Respiratory Diseases: Taking a Policy Lens. Advances in therapy, 42(6), 2569–2586. https://doi.org/10.1007/s12325-025-03191-x
- Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017;50:1700629. https://doi.org/10.1183/13993003.00629-2017
- Laska, Irena F. ‘Prevalence of Bronchiectasis: A Narrative Review’. Therapeutic Advances in Respiratory Disease, vol. 19, Oct. 2025, p. 17534666251390073. DOI.org (Crossref), https://doi.org/10.1177/17534666251390073.
- Yu L, Zhu H, Jin X, Ding J, Jin T. Therapies for bronchiectasis: mechanisms and potential effects. Frontiers. 2026:17. https://doi.org/10.3389/fimmu.2026.1735598
- Chalmers, J. D., Metersky, M., Aliberti, S., Morgan, L., Fucile, S., Lauterio, M., & McDonald, P. P. (2025). Neutrophilic inflammation in bronchiectasis. European respiratory review : an official journal of the European Respiratory Society, 34(176), 240179. https://doi.org/10.1183/16000617.0179-2024
- Chalmers JD, Burgel PR, Daley CL, et al. Phase 3 trial of the DPP-1 inhibitor brensocatib in bronchiectasis (ASPEN). N Engl J Med 2025;392(16):1569–1581. https://doi.org/10.1056/NEJMoa2411664
- Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax 2019;74(Suppl 1):1–69. https://doi.org/10.1136/thoraxjnl-2018-212463
- Chalmers JD, Polverino E, Crichton ML, et al. Bronchiectasis in Europe: data from the European Bronchiectasis Registry (EMBARC). Lancet Respir Med 2023;11:637–649.