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“Recent research has revealed that… neutrophils are not normal in bronchiectasis. I mean, they are fundamentally different. They have delayed apoptosis compared to the normal host…” Dr. Pamela McShane  Yes, it is one of those words that sounds like what it actually is. But before we get there, we need to talk about those ever-discussed immune cells called neutrophils. What are neutrophils supposed to do? Neutrophils are white blood cells that act as the body’s first responders. Their role is to rush to infection sites and kill bacteria quickly and aggressively. Just as importantly, once their job is done, neutrophils are supposed to die off promptly through a tightly regulated, natural process called apoptosis. This allows inflammation to resolve and tissues to heal. In a healthy immune system, this entire cycle is fast and well-controlled, typically completed within a few days. Neutrophils themselves are not harmful. In fact, they are essential for fighting infection. The problem arises when their activity is not properly regulated. What goes wrong in bronchiectasis?In bronchiectasis, neutrophils are fundamentally altered. They do not behave the way they should. Instead:
Neutrophils are meant to be short-term emergency responders. Their weapons are powerful by design, but they are intended to be used briefly. In bronchiectasis, however, these cells linger and continue firing within already vulnerable airways. Why delayed apoptosis causes harmWhen neutrophils fail to undergo apoptosis:
The degree of delayed apoptosis and neutrophil-driven inflammation can vary from person to person, which helps explain why bronchiectasis severity and progression differ so widely among individuals. A newer approach: calming neutrophils, not eliminating themIt has been about five months since some people started Brinsupri™, and early feedback is beginning to emerge. Many who choose to share their experiences publicly report benefits such as less breathlessness and more energy. Everyone’s experience is different, but these early observations are encouraging. So how does Brinsupri (brensocatib) work? Brinsupri does not stop the body from making neutrophils. The immune system still sends these cells into the lungs as usual. What Brinsupri appears to do is make neutrophils less damaging. This reflects a reduction in harmful neutrophil-driven inflammation rather than elimination of neutrophils or suppression of the immune system. With Brinsupri, neutrophils remain present but tend to be less aggressive, cause less irritation and injury, and trigger less ongoing inflammation. In simple terms, Brinsupri helps calm neutrophils down. It does not kill them. It does not force them to die sooner. It helps reduce the ongoing lung tissue damage they can cause once they reach the lungs. These therapies are intended to limit inflammatory injury and may help slow disease progression, but they do not reverse existing structural airway damage. Deciding when or whether to consider treatmentSome people are choosing to wait to see how others respond to the new medication. This can be a reasonable and thoughtful approach.
However, if your lung function is declining or you are experiencing frequent exacerbations, the ongoing damage also needs to be considered. Each exacerbation can leave lasting effects on the airways and influence long-term outcomes. At your next medical visit, consider asking your clinician about Brinsupri and whether it might be an option for you. There are also similar therapies currently in clinical trials that may become available where you live. Understanding the biology behind bronchiectasis empowers patients to have more informed, collaborative conversations with their care teams. Educate. Self-advocate. Share information with others.
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As a personal trainer, I have always enjoyed lifting weights. Now, with bronchiectasis and a history of MAC, I have an extra reason to stay strong.  I am at the gym most days and often write social media posts or work with clients in between 30-minute workout sessions. Some days I complete one session, other days two, and occasionally I add a shorter half-session depending on how my body feels. Fueling Before and After WorkoutsBefore heading to the gym, I always eat. That might include peanut butter on toast, Greek yogurt, eggs, a banana, or berries, along with my must-have coffee. After my workout, I eat again, making sure to include both protein and carbohydrates. This consistent fueling is the only way I have enough energy to train and the ability to build and maintain muscle. Without adequate nutrition, strength gains are limited, especially for those of us managing chronic lung conditions. Training With Breathing in MindLately, I have been separating my upper- and lower-body workouts, but there is no single right approach. What matters most is paying attention to balance. I focus on strengthening my chest and neck muscles to support airway clearance, while also stretching them to prevent tightness and neck pain. As I discuss in my book, The BE CLEAR Method to Living with Bronchiectasis, it is equally important to strengthen and stretch the back muscles. People with bronchiectasis often round forward during coughing and while using airway clearance devices. Addressing both the front and back of the body helps counteract this pattern. A Functional, Whole-Body ApproachThis front-and-back approach supports posture, breathing, overall strength, and endurance. It also builds confidence. Strong muscles help make daily activities easier and breathing more efficient. Start slowly. The exercises in my book are well-suited for beginners and also helpful for more experienced exercisers who want to identify imbalances and build full-body strength. A Few Important RemindersAlways nourish your body before and after exercise. Without proper fueling, it is difficult to achieve meaningful results. If you have GERD, you may need to wait a bit after eating before exercising.
As discussed in a previous post, including a carbohydrate can help absorb stomach fluid and reduce reflux. Before starting, stopping, or changing any exercise program, be sure to get medical clearance from your physician. You can find my book on Amazon! In the inspiring video Living and Breathing with Art, Maggie Hart shares her personal journey with bronchiectasis and chronic lung disease, a condition she has lived with since age 28.  Despite facing significant medical challenges, including two lobectomies, Maggie reflects on how art has become a powerful source of calm, grounding, and peace in her life. As a former licensed independent clinical social worker, Maggie brings a deep understanding of the emotional and mental toll of chronic illness. She speaks openly about anxiety, uncertainty, and fear, and how creative expression has helped her navigate these challenges. Through painting, Maggie finds a space where she can be fully present, momentarily setting aside illness and worry to immerse herself in the creative process. Her artwork often tells a story of strength and resilience. One particularly meaningful piece, Breath and Flowers, was created before her second lobectomy and helped Maggie reframe her lungs as something beautiful and life giving rather than something to fear. She also shares her old doors series, which symbolizes the doors that close and open throughout life, mirroring the emotional journey so many people experience while living with chronic illness. The video includes a gentle, guided art exercise using only a pen and paper. It is designed to help viewers slow down, relax, and tap into their imagination. Maggie emphasizes that artistic ability is not required, reminding us that we are all wired for art and self-expression. She also offers a thoughtful reminder to be mindful of art supplies that may be harsh on the lungs, reinforcing the importance of creativity that supports both emotional and physical well-being. Maggie’s message is a beautiful reminder that art can be more than a hobby. It can be a tool for healing, reflection, and connection, especially for those navigating life with chronic illness. Thank you, Maggie, for sharing your story. You are the soul of our bronchiectasis community. Maggie's Video
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AuthorLinda Cooper Esposito, MPH is a health educator with bronchiectasis. She developed the BE CLEAR Method to Living with Bronchiectasis and writes with compassion and humor about this chronic lung disease. Archives
January 2026
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