Key Areas of Research and Emerging Therapies In Bronchiectasis Treatment

EP: 1.Overview of Bronchiectasis

EP: 2.Prognosis For Patients Diagnosed With Bronchiectasis

EP: 3.Indicators Leading to Bronchiectasis Testing and Diagnosis

EP: 4.Complications Associated With Bronchiectasis

EP: 5.Current Treatment Options For Bronchiectasis

EP: 6.Respiratory and Physical Therapists Contributing to Comprehensive Bronchiectasis Care

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EP: 7.Key Areas of Research and Emerging Therapies In Bronchiectasis Treatment

EP: 8.Diagnosing and Understanding the Pathogenesis of Bronchiectasis

EP: 9.Improving Long-Term Outlook: CT Scans and Underdiagnosis of Bronchiectasis

EP: 10.Bronchiectasis Exacerbation Management

EP: 11.Social Burden and Goals of Therapy for Patients with Bronchiectasis

EP: 12.Patient Specific Factors: Guiding Treatment in Bronchiectasis

EP: 13.Individualized Therapy for Specific Infections Associated with Bronchiectasis

EP: 14.Other Challenges With Bronchiectasis and Key Takeaways

EP: 15.Identifying Bronchiectasis: Key Clinical Presentations to Consider

EP: 16.Differentiating Bronchiectasis from COPD and Understanding Exacerbations

EP: 17.Long-Term Impact of Bronchiectasis Exacerbations: Disease Progression, Patient Outcomes, and Economic Burden

EP: 18.Managing Bronchiectasis: Treatment Goals, Outcome Measures, and Clinical Decision Resources

EP: 19.Addressing Knowledge Gaps and Treatment Strategies in Bronchiectasis

EP: 20.Challenges and Future Directions in Bronchiectasis Management

This is a video synopsis/summary of an Insights involving Mark Metersky, MD, FCCP, on emerging bronchiectasis research and key takeaways.

Many new experimental bronchiectasis therapies are under investigation with increased pharmaceutical industry interest. One medication class is dipeptidyl-peptidase (DPP-1) inhibitors which block neutrophil serine protease activation (like neutrophil elastase) without impairing other neutrophil functions. Neutrophil elastase directly causes bronchiectasis inflammation and tissue damage. A DPP-1 inhibitor phase 2 trial demonstrated reduced exacerbations. Multiple similar agents are under study.

Research into bronchiectasis endotypes (underlying characteristics) also shows promise for precision therapy approaches. About 20% of bronchiectasis patients have eosinophil-predominant inflammation. Some case reports suggest possible benefits from asthma biologic medications in this subgroup. Also, the historical practice of avoiding inhaled corticosteroids due to infection risks like nontuberculous mycobacteria is being reevaluated given the potential advantages of treating eosinophilic inflammation.

Another emerging endotype is primary ciliary dyskinesia (PCD) among adults with bronchiectasis, found to be around 10% rather than the previous estimate of 1% to 2%. Biotechnology investigations target whether improving ciliary function in PCD bronchiectasis could improve outcomes. Additionally, significant percentages of noncystic fibrosis bronchiectasis patients have single mutant cystic fibrosis transmembrane conductance regulator (CFTR) genes. Early CFTR modulator research is underway for such heterozygotes.

In summary, key points are that bronchiectasis remains underdiagnosed with an average of 5- to 10-year delays from symptom onset, often initially misattributed to asthma or chronic obstructive pulmonary disease. Clinicians should maintain a low threshold for CT diagnostic imaging given bronchiectasis treatment benefits. Though incurable, evidence-based supportive treatments significantly improve symptoms and quality of life for many patients. Exciting near-future targeted therapies seem probable given expanding pharmaceutical interest and research.

Video synopsis is AI-generated and reviewed by AJMC® editorial staff.