Bronchiectasis Learning Hub
One place for in-depth information, up-to-date research, and practical tools
for people living with bronchiectasis and their families.
In 2025, the first-ever dedicated drug for this condition was approved. Here you will find citations from peer-reviewed articles, links to studies, and information to help you stay one step ahead.
What is Bronchiectasis?
Basic understanding of the disease
Treatments & Medications
Approved drugs and emerging therapies
Clinical Trials
Active research studies worldwide
Latest Research
Breakthroughs and recent discoveries
Airway Clearance
Physiotherapy techniques and devices
Infections & Exacerbations
Prevention and management of flare-ups
Nutrition
Foods and supplements for lung health
Living with the Condition
Daily routine, exercise, and mental health
Support Organizations
Patient groups and communities
Resources & Links
Organizations, apps, and reading
What is Bronchiectasis?
A deep understanding of the disease, its types, causes, and diagnosis
What is Bronchiectasis?
A chronic lung disease characterized by permanent, irreversible widening of the walls of the bronchi. The structural damage to the airways leads to impaired mucus clearance, chronic bacterial infections, and progressive lung injury. The name derives from the Greek: bronkhia (airways) + ektasis (widening).
Cole's Vicious Cycle
The central model explaining the disease is Cole's "Vicious Cycle" (1986): initial injury → mucus accumulation → chronic bacterial infection → neutrophilic inflammation → structural airway damage → further impairment of clearance, and the cycle repeats.
Rising Global Prevalence
The prevalence of bronchiectasis has been rising in recent decades worldwide. A 2024 meta-analysis of 15 studies found 680 cases per 100,000 people. In the UK, prevalence rose 20% between 2008 and 2012. Reasons include improved imaging (HRCT), greater clinical awareness, and an aging population.
The Three Morphological Types
| Type | Description | Severity | HRCT appearance |
|---|---|---|---|
| Cylindrical | Uniformly dilated bronchi with straight walls. The most common type. | Mild | "Tram-track" sign and "signet ring" sign |
| Varicose | Bronchi with alternating areas of dilation and constriction, resembling varicose veins. | Moderate | Irregular, beaded bronchial contour |
| Cystic / Saccular | Bronchi forming clusters of large cysts, sometimes with fluid levels. | Severe | Thin-walled cyst clusters with air-fluid levels |
Major Causes
Post-Infectious (30.5%)
The most common cause worldwide. Includes childhood pneumonia, whooping cough, measles, and tuberculosis. TB alone accounts for 14.1% of cases.
Idiopathic (28.7%)
No identifiable cause despite thorough investigation. In the European EMBARC registry, 38.1% of cases are idiopathic.
Cystic Fibrosis (12.5%)
An autosomal recessive genetic disease and the best-known hereditary cause in Western countries.
Additional Causes
Immunodeficiency (9.4%), COPD (7%), asthma (5.2%), primary ciliary dyskinesia (PCD, 2.9%), allergic bronchopulmonary aspergillosis (ABPA, up to 8%), autoimmune diseases (1.4%), alpha-1 antitrypsin deficiency, gastroesophageal reflux (GERD), and congenital malformations.
Frequently Asked Questions
Treatments & Medications
Approved therapies, new drugs, and antibiotics
Historic Breakthrough: Brensocatib (BRINSUPRI)
In August 2025 the FDA approved the first-ever drug specifically for non-CF bronchiectasis. Brensocatib is a DPP1 (Dipeptidyl Peptidase 1) inhibitor that reduces the activity of neutrophil enzymes responsible for airway damage. In the ASPEN trial (1,721 participants, NEJM 2025) it produced a 21% reduction in the annual exacerbation rate.
Key Treatments per ERS 2025 Guidelines
Brensocatib (BRINSUPRI)
Mechanism: DPP1 inhibitor reducing neutrophil enzymes (elastase, cathepsin G, proteinase 3).
Dose: 10 mg or 25 mg tablet once daily.
Manufacturer: Insmed. FDA approval: August 2025; EU approval: October 2025.
Side effects: Upper respiratory tract infection, headache, rash, dry skin, hypertension.
Macrolides (Azithromycin)
Strong recommendation for high-risk patients (2+ exacerbations/year). Three major trials: EMBRACE (62% reduction), BAT (34%), BLESS (43%). Dual mechanism: anti-inflammatory and antimicrobial. Inhibits biofilm, reduces cytokines.
Dose: 250 mg daily or 500 mg three times per week.
Bronchodilators
Salbutamol (SABA): 100–200 mcg before airway clearance therapy and hypertonic saline inhalation.
Formoterol / Tiotropium (LABA/LAMA): when reversible airflow obstruction or co-existing COPD is present.
Note: These do not alter disease course, but relieve symptoms and facilitate clearance.
Hypertonic Saline (Inhaled)
Mechanism: Raises airway osmolarity, improves mucociliary clearance, and reduces mucus viscosity.
Dose: 4 ml of 6–7% NaCl, inhaled 1–2 times per day.
Important: Inhale a bronchodilator first to prevent bronchospasm.
Dornase Alfa (Pulmozyme)
Contraindicated in non-CF bronchiectasis! A randomised trial of 349 adults showed that the drug caused more exacerbations and a greater decline in FEV1 compared with placebo. It is recommended only in cystic fibrosis.
Inhaled Corticosteroids (ICS)
ERS 2025 guidelines recommend against routine use of inhaled corticosteroids in bronchiectasis. Appropriate only in patients with co-existing asthma or eosinophilic COPD. No evidence of benefit in bronchiectasis alone, and increased risk of infection.
Antibiotics for Exacerbations and Long-Term Suppression
Acute Exacerbations (14-day treatment course)
First line: Amoxicillin 500 mg three times daily or amoxicillin-clavulanate 875/125 mg twice daily.
Suspected Pseudomonas: Ciprofloxacin 500–750 mg twice daily.
IV therapy (severe cases): Piperacillin-tazobactam, ceftazidime, meropenem, or IV tobramycin.
Long-Term Inhaled Antibiotics (for chronic Pseudomonas)
Strong recommendation in ERS 2025 guidelines for patients with chronic Pseudomonas aeruginosa infection at high risk of exacerbations.
| Drug | Route | Dose | Notes |
|---|---|---|---|
| Tobramycin (TOBI) | Inhaled (solution) | 300 mg twice daily, 28 days on/28 off | High microbiological efficacy |
| Tobramycin powder (TIP) | Inhaled (DPI) | 112 mg twice daily, 28 on/off | Most microbiologically effective (2025 meta-analysis) |
| Colistin (Promixin) | Inhaled (nebuliser) | 1–2 ml twice daily | Strong observational evidence |
| Gentamicin | Inhaled (nebuliser) | 80 mg twice daily | Excellent long-term microbiological efficacy |
2024 Meta-Analysis (CHEST)
A systematic review found that inhaled antibiotics significantly reduce exacerbation frequency (Rate Ratio 0.79; 95% CI 0.68–0.91; P = 0.0009).
Therapies in Development
BI 1291583 (Verducatib)
Phase 3 | Boehringer Ingelheim
Mechanism: Cathepsin C (DPP1) inhibitor — same target as brensocatib but a different molecule.
AIRTIVITY trial: ~1,200 adults, 52–76 weeks. Enrollment began in 2025, building on positive Phase 2 AIRLEAF results.
HSK31858
Phase 2 (China) | Haisco Pharmaceutical
A third DPP1 inhibitor. SAVE-BE trial (226 patients): 48–59% reduction in exacerbation rate. Stronger Phase 2 results than brensocatib, though cross-trial comparisons require caution.
Benralizumab (Fasenra)
Phase 3 | AstraZeneca
Monoclonal antibody against IL-5Rα. MAHALE trial (NCT05006573): targeting the eosinophilic endotype of bronchiectasis specifically. Already approved for severe eosinophilic asthma.
AP-PA02 (Bacteriophages)
Phase 2 | Armata Pharmaceuticals
Inhaled bacteriophage cocktail against Pseudomonas aeruginosa. TAILWIND trial (2024): durable reduction in bacterial lung burden. A novel approach with potential to address antibiotic-resistant strains.
ARINA-1 (RVN-301)
Phase 2 completed | Renovion
Inhaled mucoactive and anti-inflammatory agent. CLIMB trial: quality-of-life improvement more than 2× the MCID, reduced mucus viscosity and neutrophil elastase activity. Phase 3 in preparation.
Itepekimab
Phase 2 completed | Sanofi/Regeneron
Monoclonal antibody against IL-33. Blocks alarmin signalling in type 2 and non-type 2 inflammation. Results expected in 2026 (NCT06280391).
Important Questions to Ask Your Doctor
About Your Diagnosis
• What is my morphological type (cylindrical, varicose, cystic)?
• What is the underlying cause? Have all possible causes been investigated?
• What are my BSI and FACED scores?
• How many lung lobes are involved?
About Your Treatment
• Am I a candidate for long-term macrolide therapy?
• Is Brensocatib (BRINSUPRI) appropriate for me?
• Do I need inhaled antibiotics?
• Which airway clearance technique is right for me?
• Should I be using hypertonic saline inhalation?
About Follow-Up
• How often should I have sputum cultures?
• Do I have Pseudomonas colonization?
• What are the warning signs of an exacerbation?
• When should I go to the emergency department?
• Should I be referred for pulmonary rehabilitation?
Clinical Trials
Active and recently completed studies 2024–2026
A New Era in Bronchiectasis Treatment
In 2025, the first dedicated drug was approved. Three additional DPP1 inhibitors are now in development, alongside biologics targeting specific endotypes and novel approaches such as bacteriophage therapy. This is the most active research period in the history of bronchiectasis.
ASPEN — Brensocatib (NCT04594369)
1,721 participants | Insmed | The largest bronchiectasis trial in history. Led to FDA approval (August 2025) and EU approval (October 2025). 21% reduction in annual exacerbation rate. Published in NEJM, April 2025.
AIRTIVITY — BI 1291583 / Verducatib (NCT06872892)
~1,200 adults | Boehringer Ingelheim | Second DPP1 inhibitor. 52–76 weeks of treatment. Building on positive results from the AIRLEAF Phase 2 trial.
MAHALE — Benralizumab (NCT05006573)
AstraZeneca | Anti-IL-5Rα monoclonal antibody for eosinophilic bronchiectasis. 28–52 weeks of treatment plus a 32-week open-label extension.
SAVE-BE — HSK31858 (China)
226 patients at 25 centres | Haisco | 48–59% reduction in exacerbations. Published in Lancet Respiratory Medicine 2025.
Itepekimab (NCT06280391)
Sanofi/Regeneron | Anti-IL-33 monoclonal antibody. Results expected in 2026.
TAILWIND — AP-PA02 (NCT05616221)
Armata Pharmaceuticals | Inhaled bacteriophages against Pseudomonas. Durable bacterial burden reduction. Good safety profile.
CLIMB — ARINA-1 / RVN-301 (NCT05495243)
Renovion | Inhaled mucoactive agent. Significant quality-of-life improvement, reduced mucus viscosity. Phase 3 in preparation.
Latest Research
Breakthroughs and key findings from 2025 and 2026
The Lancet Commission (2026)
The Lancet Respiratory Medicine Commission on Bronchiectasis
Chalmers JD et al. | A landmark paper redefining bronchiectasis as primarily a chronic inflammatory disease. Introduces the concept of "disease activity" with direct clinical implications. Calls for early identification of at-risk individuals and repurposing of anti-inflammatory drugs from other conditions.
ASPEN Trial (2025)
New England Journal of Medicine, 392(16):1569–1581
Chalmers JD, Burgel PR, Daley CL et al. | 1,721 participants. Proof that DPP1 inhibitors are an effective treatment — leading directly to the first-ever FDA approval for the disease. A milestone in respiratory medicine.
Precision Medicine (2024–2025)
Moving from "one treatment for all" to endotype-based therapy: Pseudomonas (neutrophilic), Haemophilus, eosinophilic, and mucus hypersecretion. New biomarkers: sputum neutrophil elastase (NEATstik), blood eosinophils, sputum procalcitonin. Neutrophilic patients benefit from DPP1 inhibitors; eosinophilic patients from biologics.
DPP1 Inhibitor Meta-Analysis (2025)
Respiratory Research (Springer Nature)
A GRADE analysis of all DPP1 inhibitor trials confirms a class effect: consistent exacerbation reduction across brensocatib, BI 1291583, and HSK31858. Three different molecules, one mechanism, the same outcome.
ERS 2025 Guidelines
European Respiratory Journal, 66(6):2501126
The first guidelines to incorporate brensocatib as a recommended treatment. Strong recommendations for macrolides + brensocatib in patients with 2+ exacerbations/year. Expanded ACT recommendations including patients without productive cough who show mucus plugging on CT. Earlier referral for lung transplantation.
Predicting Macrolide Response (2025)
The Lancet Respiratory Medicine
Observational study characterising which patient profiles respond best to long-term macrolide therapy. An important further step toward personalised medicine in bronchiectasis.
Airway Clearance & Physiotherapy
Techniques, devices, and pulmonary rehabilitation per ERS 2025 guidelines
Strong Recommendation in ERS 2025 Guidelines
Airway clearance techniques (ACTs) are now recommended for most patients with bronchiectasis, including patients with a dry cough who show mucus plugging on CT. This is a significant change from previous guidelines that restricted ACT to patients with chronic productive cough only.
Main Techniques
ACBT (Active Cycle of Breathing Technique)
Breathing control, thoracic expansion exercises, and the forced expiration technique (huffing). The most widely used technique. Key advantage: can be performed independently without any device.
Oscillating PEP Devices
Aerobika, Acapella, Flutter — combine vibrations with positive expiratory pressure. The devices most preferred by patients for their portability and convenience. Conditional recommendation in ERS 2025 guidelines.
HFCWO Vest
An inflatable vest delivering rapid chest wall compressions (SmartVest, The Vest). Conditional recommendation. Useful when manual techniques are not practical.
Manual Chest Physiotherapy (CPT)
Percussion, postural drainage, and vibration. The traditional approach. Requires a skilled therapist or trained family member.
Autogenic Drainage
Controlled breathing at different lung volumes. Requires training but no device. ELTGOL (slow expiration with open glottis in lateral position) has been shown to reduce the risk of exacerbations and improve quality of life.
Pulmonary Rehabilitation
Strong recommendation for patients with reduced exercise capacity. Includes supervised exercise training, education, and counselling. Available at specialist respiratory centres worldwide.
Guiding Principles
• No single technique is superior to another. Treatment should be individualised.
• Session duration: 10–30 minutes, once or twice daily.
• During exacerbations: daily physiotherapy until clearance is optimal.
• It is strongly recommended to learn proper technique from a respiratory physiotherapist.
Infections & Exacerbations
Recognition, prevention, and management of flare-ups
What is an Exacerbation?
A worsening of key symptoms (increased cough, sputum volume, increased sputum purulence, breathlessness, fatigue, fever, haemoptysis) lasting at least 48 hours that requires a change in treatment (usually antibiotics). The median number of exacerbations is approximately 2 per year. More than 33% of patients experience 3 or more per year.
Chronic Airway Pathogens
| Pathogen | Prevalence | Clinical significance |
|---|---|---|
| Haemophilus influenzae | 47% | Most common at initial diagnosis. Associated with less severe disease. |
| Pseudomonas aeruginosa | 12–37% | Associated with a 2.95-fold increase in mortality. Marker of severe disease. |
| Moraxella catarrhalis | Variable | Common coloniser. |
| Staphylococcus aureus | ~7% | Primarily associated with CF-related bronchiectasis. |
| Aspergillus fumigatus | ~6% | Important: screen for ABPA. |
| Klebsiella pneumoniae | ~11.5% | More prevalent in Asian populations. |
Exacerbation Warning Signs
Signs Requiring a Doctor Visit
• Significantly increased cough
• Change in sputum colour (green/yellow)
• Increased sputum volume
• Fever above 38°C / 100.4°F
• Breathlessness worse than usual
• Unusual fatigue
Signs Requiring Emergency Care
• Significant haemoptysis (massive coughing of blood)
• Severe breathlessness at rest
• High fever that does not resolve
• Confusion or excessive drowsiness
• Blue lips or fingertips (cyanosis)
Preventing Exacerbations
• Regular airway clearance therapy
• Long-term macrolide therapy (if recommended)
• Annual influenza and pneumococcal vaccination
• Hypertonic saline inhalation (if recommended)
• Avoid smoking and air pollutants
• Balanced diet and regular exercise
Pseudomonas aeruginosa — the Key Threat
Chronic Pseudomonas colonisation is associated with a 2.95-fold increase in mortality (OR 2.95, 95% CI 1.98–4.40, P<0.0001). At first detection of Pseudomonas, eradication should be attempted with ciprofloxacin plus inhaled antibiotics. If colonisation becomes chronic: long-term inhaled antibiotics (tobramycin, colistin, or gentamicin).
Nutrition for Lung Health
Foods, supplements, and eating habits that support respiratory health
Anti-Inflammatory Foods
Oily fish (salmon, mackerel, sardines) — rich in omega-3 fatty acids that reduce inflammation.
Dark leafy vegetables (spinach, kale, broccoli) — rich in antioxidants and vitamin C.
Berries (blueberries, raspberries) — anthocyanins with anti-inflammatory properties.
Turmeric — curcumin with well-documented anti-inflammatory effects.
Adequate Protein
People with bronchiectasis, especially during exacerbations, need more protein to preserve muscle mass and support the immune system. Recommended sources: chicken, fish, eggs, legumes, tofu, yoghurt. Low BMI is a risk factor in the BSI scoring index.
Staying Well Hydrated
Adequate hydration is essential for thinning mucus and facilitating airway clearance. Aim to drink at least 8 glasses of water per day, more in hot weather or during exercise. Limit excessive caffeine intake as it can contribute to dehydration.
Key Vitamins & Minerals
Vitamin D: Supports immune function and reduces susceptibility to infection. Testing levels is recommended.
Vitamin C: Antioxidant, supports tissue repair.
Zinc: Essential for normal immune function.
Iron: Particularly important in patients with recurrent haemoptysis.
Foods to Limit
Processed foods — high in salt and saturated fats that increase inflammation.
Added sugar — weakens the immune system.
Dairy products — in some patients can increase mucus production (not scientifically proven; worth testing individually).
Alcohol — weakens the lung's defence mechanisms.
Maintaining a Healthy Weight
Low BMI (below 18.5) adds 2 points to the BSI score and is a risk factor for poor outcomes. Conversely, excess weight burdens breathing. The target is a BMI of 20–25. Dietitian referral is especially recommended for patients with unexplained weight loss.
Living with Bronchiectasis
Daily routine, exercise, mental health, and travel
Recommended Morning Routine
1. Airway clearance technique (10–30 minutes)
2. Inhale bronchodilator (if prescribed)
3. Inhale hypertonic saline (if prescribed)
4. Take medications (Brensocatib, macrolides)
5. High-protein breakfast
6. Drink plenty of fluids
Exercise
Regular physical activity is strongly encouraged and improves exercise capacity, quality of life, and mucus clearance. Recommended activities: walking, swimming, cycling. Start gradually. Exercise at an intensity that allows you to talk. Stop if you feel dizzy or severely short of breath.
Mental Health
Bronchiectasis affects anxiety, depression, and chronic fatigue. The treatment burden (physiotherapy, inhalations, medications) can take hours every day. It is normal to feel frustrated. Recommended: support groups, psychotherapy, mindfulness, and open communication with those around you.
Travel and Flying
Most people with bronchiectasis can fly and travel. Tips: carry double your medication supply, obtain a medical letter in English, familiarise yourself with the healthcare system at your destination. On long flights: drink plenty of fluids, do breathing exercises, and do not forget your PEP device. Consult your doctor before long trips.
Family and Caregivers
Family and caregivers play a critical role. It is important to learn about the disease, recognise signs of exacerbation, and support the treatment routine. Help with manual chest physiotherapy (percussion, postural drainage) can make a real difference. Do not neglect your own wellbeing — caregivers also need rest and support.
Home Environment
• Keep indoor air clean; use an air purifier
• Avoid smoking and secondhand smoke
• Reduce exposure to dust and mould
• Clean nebulisers and PEP devices regularly
• Ventilate rooms regularly
• Stay up to date with annual influenza and pneumococcal vaccines
Support Organizations & Communities
Patient groups, online communities, and support resources
International Organizations
European Lung Foundation
Dedicated bronchiectasis page with information sheets, self-management guides, and videos. Patient-friendly summary of ERS 2025 guidelines. Resources available in many languages.
Bronchiectasis News Today
Up-to-date news on treatments, clinical trials, and research. Patient stories, expert columns, and a weekly newsletter. A trusted hub for the global bronchiectasis community.
EMBARC
The European Multicentre Bronchiectasis Audit and Research Collaboration — the world's largest bronchiectasis patient registry. Drives the development of international guidelines and precision medicine research. Partners with patient organisations worldwide.
Additional Global Resources
American Lung Association
Comprehensive bronchiectasis education. Lung HelpLine: 1-800-LUNGUSA. Better Breathers Club: local support groups. Hosts World Bronchiectasis Day (1 July).
COPD Foundation / Bronchiectasis & NTM
"All About Bronchiectasis" booklet, monthly virtual support groups, dedicated information line, Bronchiectasis & NTM Care Center Network (from 2024), and the BronchandNTM360social platform.
Asthma + Lung UK
Detailed bronchiectasis information pages, free monthly BEHappy Zoom meetings for patients, and a telephone helpline. Resources include self-management plans and guidance on managing exacerbations at home.
Online Patient Communities
Online Support Communities
• BronchandNTM360social — platform for patients, caregivers, and healthcare professionals
• Smart Patients NCFB — peer support community for bronchiectasis
• Mayo Clinic MAC & Bronchiectasis Group — connect with fellow patients
• Living with Lung Disease (Inspire) — American Lung Association community
• BEHappy — free monthly Zoom meetings (Asthma + Lung UK)
• Health Unlocked — community forums for lung conditions
Resources & Links
Leading centres, apps, and recommended reading
Leading International Centres
| Centre | Location | Speciality / Notable |
|---|---|---|
| University of Dundee — Prof. James Chalmers | Dundee, UK | World-leading bronchiectasis research. ASPEN trial chief investigator. EMBARC founder. 500+ publications. |
| Hospital Vall d'Hebron — Dr. Miguel Angel Martinez-Garcia | Barcelona, Spain | Co-led ERS 2025 guidelines. Major contributions to FACED score and exacerbation prediction. |
| University of British Columbia | Vancouver, Canada | Dr. Christopher Daley — NTM and bronchiectasis specialist. Co-author ASPEN trial. |
| National Jewish Health | Denver, USA | World-renowned respiratory centre. Bronchiectasis & NTM Care Center. Specialised multidisciplinary clinics. |
| Royal Brompton Hospital | London, UK | Major CF and bronchiectasis centre. Specialised physiotherapy and long-term airway clearance programmes. |
| Hannover Medical School (MHH) | Hannover, Germany | EMBARC member. Active bronchiectasis clinical trial site. Lung transplant centre. |
Recommended Apps
MyTherapy
Medication reminders, symptom tracking, health diary, and appointment reminders.
Breathefree
Inhaler tracking, lung capacity monitoring, breathing exercises, and medication reminders.
Aluna
FDA-cleared portable spirometer. Tracks FEV1%, symptoms, medications, and environmental triggers.
Books & Guides
Recommended Reading
• "The BE CLEAR Method to Living with Bronchiectasis" — Linda Cooper Esposito, MPH. Practical tips for day-to-day self-management.
• "Living with Bronchiectasis" — CHSS (Chest Heart & Stroke Scotland). Information booklet on breathlessness, oxygen, exercise, and pulmonary rehabilitation.
• ATS Patient Education Series — free downloadable information sheets on causes, symptoms, and treatments.
Essential Links
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