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ICYMI: Highlights From CHEST 2025
Top content from this year's CHEST meeting in Chicago focused on bronchiectasis treatment, particularly the newly FDA-approved brensocatib (Brinspuri; Insmed).
Most of the top content from this year’s CHEST: American College of Chest Physicians Annual Meeting on The American Journal of Managed Care® (AJMC) website centered on bronchiectasis treatment, particularly the newly FDA-approved brensocatib (Brinspuri; Insmed). The one exception explored the potential role of glucagon-like peptide-1 (GLP-1) inhibitors in managing obstructive sleep apnea (OSA).
Below are highlights from CHEST 2025; catch up on all our coverage here.
Top content from this year's CHEST meeting in Chicago focused on bronchiectasis treatment, particularly the newly FDA-approved brensocatib (Brinspuri; Insmed). | Image Credit: Iuliia Sokolovska - stock.adobe.com
5. Integrating Brensocatib and CT Scans Into NCF Bronchiectasis Management: James Chalmers, MBChC, PhD
James D. Chalmers, MBChC, PHD, professor of respiratory medicine at the University of Dundee, presented results from “Effect of Brensocatib on Computed Tomography Outcomes in Patients With Non-Cystic Fibrosis Bronchiectasis: An Analysis of the ASPEN Trial” at the meeting. In an on-site interview with AJMC, he explained that, although CT is traditionally used to diagnose bronchiectasis, this analysis suggests it may also serve as a biomarker of treatment response.
For example, if an airway previously filled with mucus begins to clear after receiving brensocatib, this indicates treatment effectiveness and reduced patient risk. Chalmers concluded by emphasizing that brensocatib is expected to complement existing management strategies rather than replace foundational therapies, helping to prevent exacerbations and slow disease progression.
4. GLP-1s Likely New Frontier in the Treatment of OSA, Obesity in Sleep Medicine
The efficacy of GLP-1 inhibitors for weight loss has sparked interest in their potential role in treating OSA, as discussed in a CHEST 2025 session. Atul Malhotra, MD, of the University of California, San Diego, first presented data from the SURMOUNT trials, showing that tirzepatide significantly reduced apnea-hypopnea index and improved patient-reported sleep quality compared with placebo.
Following the presentation, an expert panel shared their experiences using GLP-1s in sleep medicine. Although these treatments show promise, they noted that prescribing practices in sleep medicine vary widely due to long wait times and differences in provider familiarity. The panel emphasized that GLP-1s should complement lifestyle interventions rather than replace them and may not eliminate the need for continuous positive airway pressure. They concluded by encouraging all specialists, including those who have not yet prescribed these medications, to become familiar with GLP-1s to better support patients with OSA.
3. Brensocatib Reduced Symptom Burden, Neutrophil Serine Proteases Activity in Bronchiectasis
Two CHEST 2025 abstracts highlighted the efficacy of brensocatib in reducing neutrophil serine protease (NSP) activity and alleviating symptom burden in patients with non-cystic fibrosis bronchiectasis. The first examined the impact of brensocatib on sputum NSP concentrations compared with placebo over 52 weeks of treatment and 4 weeks of follow-up. The authors determined that active brensocatib treatment reduced NSP activity within the first 4 weeks, with the 25-mg dose producing a greater reduction than the 10-mg dose.
The second abstract evaluated brensocatib’s effect on symptom burden in patients with bronchiectasis, both with and without pulmonary exacerbations, using the Bronchiectasis Exacerbation and Symptom Tool. The researchers reported reductions in symptom burden at both doses, regardless of exacerbation occurrence, with the greatest improvements observed in patients without exacerbations and those receiving the 25-mg dose.
2. Brensocatib Improves Outcomes in Non-Cystic Fibrosis Bronchiectasis With or Without Comorbid COPD
Two additional posters demonstrated brensocatib's significant clinical and structural benefits in patients with non-cystic fibrosis bronchiectasis, both with and without comorbid chronic obstructive pulmonary disease (COPD). One poster evaluated brensocatib’s impact on structural lung disease using high-resolution CT scans performed at screening and at week 52. Both 10- and 25-mg doses improved multiple CT end points, with the 25-mg dose having the greatest effect, suggesting that its impact on inflammatory processes may drive structural lung changes.
The second poster analyzed ASPEN outcomes in patients with and without comorbid COPD, focusing on exacerbation rate, time to first exacerbation, odds of remaining exacerbation-free, forced expiratory volume in 1 second (FEV1) changes, and safety. Both doses reduced exacerbations, prolonged time to first exacerbation, increased the likelihood of remaining exacerbation-free, and slowed the first second of forced expiration decline. However, serious adverse events were more common in patients with comorbid COPD.
1. Guidelines for Bronchiectasis Highlight Multiple Treatment Methods
The FDA’s approval of brensocatib earlier this year has sparked discussion on optimal disease management. This was reflected in the presentation of the new North American bronchiectasis treatment guidelines at CHEST 2025. Key recommendations include targeting antibiotics based on sputum cultures and using long-term macrolide or brensocatib therapy for patients with 2 or more exacerbations per year. In contrast, they conditionally advised against the long-term use of atorvastatin therapy in these patients. These guidelines remain preliminary, with the final version expected to be published soon for clinicians across North America and beyond.
