Opinion
Video
Key Areas of Research and Emerging Therapies In Bronchiectasis Treatment
Dr Metersky provides his closing thoughts, highlighting key points of emphasis surrounding bronchiectasis care and the future of its treatment landscape.
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.
