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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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Navigating holiday gatherings can be joyful, heartwarming, and at times a bit challenging if you are sensitive to fragrance. Most people never think twice about perfume or scented candles.
Navigating holiday gatherings can be joyful, heartwarming, and at times a bit challenging if you are sensitive to fragrance. Most people never think twice about perfume or scented candles. But for those of us with asthma, bronchiectasis, or other chronic lung conditions and hypersensitive airways, strong scents can turn a celebration into an uncomfortable experience.
Fragrance exposure can trigger coughing, chest tightness, or even an exacerbation. With a bit of preparation and open communication, you can enjoy the season while protecting your breathing and staying well.
Fragrance exposure can trigger coughing, chest tightness, or even an exacerbation. With a bit of preparation and open communication, you can enjoy the season while protecting your breathing and staying well.
How to Communicate With Your Host
If you are sensitive to scent, you can gently let your host know before the gathering. Share that you are hypersensitive to scented candles and perfume and that these products can make you feel unwell. Most hosts appreciate clear communication and want their guests to be comfortable.
Your host can then mention the scent sensitivity to invited guests or simply avoid using strongly fragranced items during the gathering. This is not being overly demanding. It is a small request that protects your health.
Your host can then mention the scent sensitivity to invited guests or simply avoid using strongly fragranced items during the gathering. This is not being overly demanding. It is a small request that protects your health.
What to Do If You Arrive and Scents Are Already Present
If you walk in and notice a scented candle burning, it is appropriate to ask if it can be removed. A considerate host would far rather put out a candle than watch a guest feel miserable during dinner. A simple and warm request is all that is needed.
Is Bringing Your Own Air Purifier Appropriate
For some people, a portable air purifier is not optional. It is a tool that prevents symptoms and helps them breathe comfortably. If this describes your situation, bringing an air purifier to Thanksgiving is entirely acceptable.
The key is to let your host know in advance. A brief explanation, such as, I have a lung condition, and bringing a small air purifier helps me stay well, is usually enough. Hosts are often grateful for the clarity.
The key is to let your host know in advance. A brief explanation, such as, I have a lung condition, and bringing a small air purifier helps me stay well, is usually enough. Hosts are often grateful for the clarity.
You Are Not a Killjoy for Protecting Your Health
People sometimes worry that asking for fragrance-free accommodations makes them appear difficult. The truth is that you are advocating for your well-being. You are not taking anything away from the celebration. You are ensuring that you can participate fully and comfortably.
A caring host wants you to feel well. They would never want a guest to become ill because of fragrance exposure.
A caring host wants you to feel well. They would never want a guest to become ill because of fragrance exposure.
A Holiday Should Be Enjoyed, Not Endured
The holidays are meant to bring connection, comfort, and shared joy. If avoiding fragrances or bringing your own air purifier helps you remain comfortable and well, you are doing the right thing—your health matters. Communicating openly makes it easier for your host to support you.
Protecting your breathing is never rude. It is responsible and thoughtful. When you take care of yourself, you can enjoy the holiday with more energy, more calm, and more presence.
Protecting your breathing is never rude. It is responsible and thoughtful. When you take care of yourself, you can enjoy the holiday with more energy, more calm, and more presence.
Do you ever laugh at yourself for not seeing the whole picture? I sure do. I remember hearing that some people with bronchiectasis and NTM are told not to drink tap water.
I thought the issue was simply the bacteria in the water itself.
I had no idea that the real concern was how those bacteria could be aspirated into the lungs through reflux. That was a true deer-in-the-headlights moment for me.
At first, I handled the issue by boiling pot after pot of water. Then I moved on to buying jugs of bottled water, which took up precious real estate in our one-bedroom apartment. Eventually, I settled on the LifeStraw pitcher, which felt like a better long-term fit.
But what never crossed my mind was that the same concerns applied to ice. Ice trays, built-in refrigerator ice makers, and even refrigerator filters can harbor bacteria and biofilm.
Once I learned that, things clicked. Now I am much more cautious with ice, and when I visit my daughters, I skip the built-in ice and water dispensers. In restaurants, I rarely order drinks that come from taps, and I avoid water coolers because they can develop internal biofilm.
Looking back, I realize I probably was not ready to understand everything all at once. I needed the information to build slowly over time. And that is perfectly okay.
Sometimes it really can feel like too much until we baby-step our way into new habits.
I had no idea that the real concern was how those bacteria could be aspirated into the lungs through reflux. That was a true deer-in-the-headlights moment for me.
At first, I handled the issue by boiling pot after pot of water. Then I moved on to buying jugs of bottled water, which took up precious real estate in our one-bedroom apartment. Eventually, I settled on the LifeStraw pitcher, which felt like a better long-term fit.
But what never crossed my mind was that the same concerns applied to ice. Ice trays, built-in refrigerator ice makers, and even refrigerator filters can harbor bacteria and biofilm.
Once I learned that, things clicked. Now I am much more cautious with ice, and when I visit my daughters, I skip the built-in ice and water dispensers. In restaurants, I rarely order drinks that come from taps, and I avoid water coolers because they can develop internal biofilm.
Looking back, I realize I probably was not ready to understand everything all at once. I needed the information to build slowly over time. And that is perfectly okay.
Sometimes it really can feel like too much until we baby-step our way into new habits.
“I am strong, I am resilient, I embrace gratitude for each breath I take.”
This is my daily meditation mantra, and it reflects the way I choose to move through life while living with bronchiectasis for more than 30 years.
This is my daily meditation mantra, and it reflects the way I choose to move through life while living with bronchiectasis for more than 30 years.
I was diagnosed long before most people knew what this disease was or how to treat it. I have had two lobectomies and have faced every challenge bronchiectasis can bring. I continue to survive and thrive through determination, self-education, and fierce advocacy for myself.
A Life Built on Movement and Mindfulness
Exercise has always been my constant companion. I had an early intuition that making my lungs as strong as possible would help protect my health. I was a long-distance runner in my younger years. Now, at age 66, I practice yoga, meditation, and aerobic exercise several times a week. Movement keeps me grounded, focused, and emotionally steady.
Finding New Purpose Through Creativity
Before going on full disability due to BE, I worked as a Licensed Independent Clinical Social Worker. When that chapter closed, I turned to creativity. Art became my new way of expressing myself, first through watercolor and then through digital AI art.
I am now an award-winning watercolor artist and digital creator. Art continues to bring me presence, joy, and emotional release.
One of my greatest joys is creating AI images for children with cancer. I am part of a global Facebook community that sends artwork to pediatric cancer units around the world. It is one small way to offer comfort, connection, and imagination during the hardest moments. A mission that is very close to my heart.
I am now an award-winning watercolor artist and digital creator. Art continues to bring me presence, joy, and emotional release.
One of my greatest joys is creating AI images for children with cancer. I am part of a global Facebook community that sends artwork to pediatric cancer units around the world. It is one small way to offer comfort, connection, and imagination during the hardest moments. A mission that is very close to my heart.
Living with Bronchiectasis Not Defined by It
Bronchiectasis has not stopped me from living. It has given me a deeper sense of purpose. I embrace joyful moments, practice gratitude for every day of wellness, and create space for physical, emotional, and spiritual self-care. I am deeply grateful for this BE community. We share compassion, support, knowledge, and encouragement. It is so much easier to cope when we remember that none of us is alone.
Hope for the Future with Brinsupri
In August, with FDA approval of the first-ever treatment for bronchiectasis, I was grateful to be among the first patients to begin taking Brinsupri™. My early response was encouraging, with less lung inflammation and a surge of energy. I had to pause treatment because of an unrelated issue. I remain hopeful and excited to resume in the New Year.
Having bronchiectasis means pacing ourselves. It means showing up for the things we care about, but doing them in a way that respects our energy.
It means offering to help, but choosing the parts we can do comfortably and at our own pace.
It also means conserving energy so we can enjoy the festivities too. And remember, you never have to overexplain yourself. The people who love and care about you do not need a manual to understand that you are doing your best.
As you plan and prepare for Thanksgiving and the upcoming holidays, keep this gentle reminder close.
It also means conserving energy so we can enjoy the festivities too. And remember, you never have to overexplain yourself. The people who love and care about you do not need a manual to understand that you are doing your best.
As you plan and prepare for Thanksgiving and the upcoming holidays, keep this gentle reminder close.
Mention the word “microbiome” and my ears perk up. So you can imagine how excited I was to visit Dr. Leopoldo Segal’s laboratory at NYU Langone.
His team focuses on the lung microbiome, and much of their research involves identifying non-culturable microbes that live in the lungs and may influence whether or not we experience exacerbations.
Why I Joined the NYU Biobank
I am genuinely thrilled to participate in the biobank. Years ago, I signed off on them having access to my data and all bodily secretions. It was my way of contributing to science because I often do not qualify for clinical studies for bronchiectasis or MAC infections due to my low frequency of exacerbations.
Call me a little eccentric, but knowing that my data, sputum, and blood are now in their system and biobanks makes me feel proud.
Much more on this to come.
Call me a little eccentric, but knowing that my data, sputum, and blood are now in their system and biobanks makes me feel proud.
Much more on this to come.
Why Patient Input Matters in Research
There are so many ways to get involved in research, whether by participating in a clinical trial or simply taking the time to complete surveys. I used to think those survey requests were a way for companies to sell my information to insurance companies. I was skeptical until I learned more.
Now I understand that the FDA requires patient input, which is why so many surveys exist. And when companies decide where to invest their research dollars, they rely on hearing from us to understand what the community truly needs.
Now I understand that the FDA requires patient input, which is why so many surveys exist. And when companies decide where to invest their research dollars, they rely on hearing from us to understand what the community truly needs.
Surveys Count as Research
So now, even when I am not feeling motivated, I still fill out the initial screening questions to see if I qualify for an interview or a detailed survey. That is also research.
And that counts.
And that counts.
An Upcoming Research Opportunity for Our Community
After Thanksgiving, I will post an opportunity for our community to participate in a new survey.
I hope you will keep all of this in mind and fill out the preliminary information. And the good news is that we will be paid for our time. I firmly believe that all stakeholders should be on equal footing. Scientists are compensated for their time and expertise, and we should be too.
If you choose to donate your honorarium to charity, that is entirely your decision. What matters most is that we have a seat at the table and that our time is valued.
I hope you will keep all of this in mind and fill out the preliminary information. And the good news is that we will be paid for our time. I firmly believe that all stakeholders should be on equal footing. Scientists are compensated for their time and expertise, and we should be too.
If you choose to donate your honorarium to charity, that is entirely your decision. What matters most is that we have a seat at the table and that our time is valued.
The 2nd North American Bronchiectasis and NTM Conference Patient Education Program will take place on December 1, 2025, and it is completely free to attend.
You can join in person at NYU Langone Health or participate virtually from anywhere. Many of our favorite bronchiectasis and NTM experts will be speaking, along with new voices who are helping shape the future of care, research, and patient support.
This annual event brings together leading clinicians, researchers, advocates, and patients for a full day of learning, connection, and practical guidance. Whether you are newly diagnosed or have been living with bronchiectasis or NTM for years, this conference offers valuable insights into clinical care, airway clearance, inflammation, genetics, environmental factors, and the latest research discoveries.
This annual event brings together leading clinicians, researchers, advocates, and patients for a full day of learning, connection, and practical guidance. Whether you are newly diagnosed or have been living with bronchiectasis or NTM for years, this conference offers valuable insights into clinical care, airway clearance, inflammation, genetics, environmental factors, and the latest research discoveries.
Why You Should Attend
This program delivers high quality education covering topics such as
clinical care networks, international data, global advocacy, NTM epidemiology, genetics, airway inflammation, guideline updates, and emerging clinical trials.
You will hear directly from respected leaders in the field, including:
Dedicated question and answer sessions give attendees the chance to hear expert perspectives on the issues that matter most.
clinical care networks, international data, global advocacy, NTM epidemiology, genetics, airway inflammation, guideline updates, and emerging clinical trials.
You will hear directly from respected leaders in the field, including:
- Dr Timothy Aksamit
- Dr Doreen Addrizzo Harris
- Dr Ashwin Basavaraj
- Dr Charles Daley
- Dr David Kamelhar
- Dr Shannon Kasperbauer
- Dr Ted Marras
- Dr Marcela Munoz
- Dr Anne O’Donnell
- Dr Kenneth Olivier
Dedicated question and answer sessions give attendees the chance to hear expert perspectives on the issues that matter most.
Registration Details
Sign up now to hold your spot:
.nyulangone.org/care-services/bronchiectasis-ntm-program/ntm-patient-education-program
Interested in attending the professional conference virtually? ($399)
Contact Marla Hymes at
[email protected]
212 263 5183
.nyulangone.org/care-services/bronchiectasis-ntm-program/ntm-patient-education-program
Interested in attending the professional conference virtually? ($399)
Contact Marla Hymes at
[email protected]
212 263 5183
Agenda for December 1, 2025
9:30 AM
Registration
10:00 AM
Opening Remarks – Doreen Addrizzo Harris, MD
10:05 AM
US Clinical Care Networks – Doreen Addrizzo Harris, MD
10:15 AM
Canadian Database and Updates – Ted Marras, MD, MSc
10:30 AM
Updates from Latin America – Marcela Munoz, MD
10:45 AM
Global Awareness and Advocacy Initiatives – Timothy Aksamit, MD
11:00 AM
Epidemiology and The Environment with NTM – David Kamelhar, MD
11:15 AM
Question and Answer
11:35 AM
Break and Lunch
12:15 PM
Genetics in Bronchiectasis – Kenneth Olivier, MD, MPH
12:30 PM
Inflammation in Bronchiectasis – Anne O’Donnell, MD
12:45 PM
Guideline Updates – Ashwin Basavaraj, MD
1:00 PM
NTM Updates – Shannon Kasperbauer, MD
1:15 PM
Clinical Trial Update and Future Research Directions – Charles Daley, MD
1:30 PM
Question and Answer
1:50 PM
Closing Remarks – David Kamelhar, MD
Registration
10:00 AM
Opening Remarks – Doreen Addrizzo Harris, MD
10:05 AM
US Clinical Care Networks – Doreen Addrizzo Harris, MD
10:15 AM
Canadian Database and Updates – Ted Marras, MD, MSc
10:30 AM
Updates from Latin America – Marcela Munoz, MD
10:45 AM
Global Awareness and Advocacy Initiatives – Timothy Aksamit, MD
11:00 AM
Epidemiology and The Environment with NTM – David Kamelhar, MD
11:15 AM
Question and Answer
11:35 AM
Break and Lunch
12:15 PM
Genetics in Bronchiectasis – Kenneth Olivier, MD, MPH
12:30 PM
Inflammation in Bronchiectasis – Anne O’Donnell, MD
12:45 PM
Guideline Updates – Ashwin Basavaraj, MD
1:00 PM
NTM Updates – Shannon Kasperbauer, MD
1:15 PM
Clinical Trial Update and Future Research Directions – Charles Daley, MD
1:30 PM
Question and Answer
1:50 PM
Closing Remarks – David Kamelhar, MD
Need to Make Changes to Your Registration?
Contact Marla Hymes at
[email protected]
212 263 5183
Reach out if:
#bronchiectasis #NTM
[email protected]
212 263 5183
Reach out if:
- You registered for virtual attendance but now prefer to attend in person
- You registered for in person attendance but now prefer to attend virtually
#bronchiectasis #NTM
Did you know there’s an association between bronchiectasis and gastric reflux, as well as between NTM pulmonary disease and reflux?
Now, more than ever, leading U.S. bronchiectasis care centers are focusing on the role of gastric reflux. If your care team hasn’t evaluated you for reflux, it’s worth discussing.
Why Reflux Matters
Managing reflux can be crucial to preventing disease progression. Airway clearance alone might not be enough to stop inflammation and infection.
Some individuals manage acid reflux with antacids, alginates, or medications like Pepcid. Others may need proton pump inhibitors (PPIs) such as Nexium or Prilosec to prevent precancerous conditions like erosive esophagitis or Barrett’s esophagus.
However, the goal is often to minimize PPI use because stomach acid is needed to break down food and kill bacteria. Long-term use of these medications can cause nutrient malabsorption and bone loss. And, according to gastroenterologist Dr. Jeffrey King, lowering acid does not decrease reflux. Surprisingly, it can increase non-acid reflux.
Some individuals manage acid reflux with antacids, alginates, or medications like Pepcid. Others may need proton pump inhibitors (PPIs) such as Nexium or Prilosec to prevent precancerous conditions like erosive esophagitis or Barrett’s esophagus.
However, the goal is often to minimize PPI use because stomach acid is needed to break down food and kill bacteria. Long-term use of these medications can cause nutrient malabsorption and bone loss. And, according to gastroenterologist Dr. Jeffrey King, lowering acid does not decrease reflux. Surprisingly, it can increase non-acid reflux.
Silent Reflux and LPR
While PPIs reduce acid production, they do not stop reflux. There is a condition called silent reflux, also known as laryngopharyngeal reflux (LPR). This involves the reflux of solids, liquids, and gases that can be both non-acidic and acidic.
Substances such as water, milk, or bile, which are alkaline, can also reflux into the throat and voice, causing symptoms such as a sore throat, drippy nose, and hoarseness. Even though these substances are not acidic, they can still reach the lungs and potentially cause tissue damage, chronic inflammation, and disrupt the lung microbiome.
Substances such as water, milk, or bile, which are alkaline, can also reflux into the throat and voice, causing symptoms such as a sore throat, drippy nose, and hoarseness. Even though these substances are not acidic, they can still reach the lungs and potentially cause tissue damage, chronic inflammation, and disrupt the lung microbiome.
Steps You Can Take
If you have reflux, it’s important to take it seriously. Lifestyle changes can make a big difference:
These habits can help reduce reflux episodes and improve overall well-being.
Always consult your physician before making any changes to your treatment plan. Together, you can find the best approach to manage reflux and support your lung health.
- Avoid eating several hours before lying down, exercising, and airway clearance
- Elevate the head of your bed
- Avoid trigger foods such as fatty foods, alcohol, caffeinated and carbonated drinks, and chocolate
- Manage stress and anxiety
These habits can help reduce reflux episodes and improve overall well-being.
Always consult your physician before making any changes to your treatment plan. Together, you can find the best approach to manage reflux and support your lung health.
“This multi-modality strategy has long been the standard for other chronic diseases, such as congestive heart failure, and bronchiectasis warrants an equally nuanced approach.” Dr PJ McShane
In a recent editorial published by Dr. Pamela McShane of the National Institutes of Health (NIH), she describes brensocatib, now marketed as BRINSUPRI™, as a breakthrough for the bronchiectasis community. This first-in-class DPP-1 inhibitor marks an important step forward in reducing inflammation and exacerbations for people living with bronchiectasis.
However, Dr. McShane emphasizes that it is unrealistic to expect one drug to meet every patient’s needs. Instead, she encourages both clinicians and patients to view BRINSUPRI™ as part of a broader treatment plan that includes mucoactive agents, airway-clearance techniques, and, when appropriate, macrolide therapy.
However, Dr. McShane emphasizes that it is unrealistic to expect one drug to meet every patient’s needs. Instead, she encourages both clinicians and patients to view BRINSUPRI™ as part of a broader treatment plan that includes mucoactive agents, airway-clearance techniques, and, when appropriate, macrolide therapy.
Where BRINSUPRI™ Fits in the Treatment Landscape
For individuals already receiving long-term macrolide therapy, adding BRINSUPRI™ may further improve outcomes by targeting inflammation through a different mechanism.
For those living with nontuberculous mycobacterial (NTM) infections, where macrolide therapy may not be possible due to resistance concerns, a DPP-1 inhibitor such as BRINSUPRI™ could represent an alternative strategy to interrupt the ongoing cycle of inflammation, infection, and mucus dysfunction that drives bronchiectasis progression.
For those living with nontuberculous mycobacterial (NTM) infections, where macrolide therapy may not be possible due to resistance concerns, a DPP-1 inhibitor such as BRINSUPRI™ could represent an alternative strategy to interrupt the ongoing cycle of inflammation, infection, and mucus dysfunction that drives bronchiectasis progression.
Evidence from the WILLOW Study
Dr. McShane referenced findings from a subgroup analysis of the WILLOW study, where participants with Pseudomonas aeruginosa infection experienced a significant reduction in exacerbations when treated with brensocatib compared with placebo.
This suggests that BRINSUPRI™ could benefit patients with chronic bacterial colonization, one of the most challenging aspects of managing bronchiectasis.
This suggests that BRINSUPRI™ could benefit patients with chronic bacterial colonization, one of the most challenging aspects of managing bronchiectasis.
The Importance of Multi-Mechanism Strategies
During her guest appearance at a Bronchiectasis and NTM Association support group, Dr. McShane reiterated that while DPP-1 inhibitors represent an exciting advance, they do not address every biological mechanism involved in bronchiectasis.
She emphasized that future therapies must also target airway-epithelial health, mucus viscosity, and host-pathogen interactions to achieve long-term improvement.
Dr. McShane also compared this approach to the multi-modality treatments already used for other chronic diseases such as congestive heart failure. Bronchiectasis, she argued, deserves an equally comprehensive and individualized model that combines medications, airway clearance, exercise, and infection control for the best outcomes.
She emphasized that future therapies must also target airway-epithelial health, mucus viscosity, and host-pathogen interactions to achieve long-term improvement.
Dr. McShane also compared this approach to the multi-modality treatments already used for other chronic diseases such as congestive heart failure. Bronchiectasis, she argued, deserves an equally comprehensive and individualized model that combines medications, airway clearance, exercise, and infection control for the best outcomes.
BRINSUPRI™ represents a long-awaited milestone, but it is only the beginning. The future of bronchiectasis management depends on integrated, multi-mechanism treatment plans that address both airway inflammation and mucus dysfunction, two central challenges of this complex condition.
Editorial Reference:
P.J. McShane. Are Dipeptidyl Peptidase-1 Inhibitors the Future Anti-inflammatory Treatment in Bronchiectasis? Archivos de Bronconeumología. DOI: 10.1016/j.arbres.2025.09.002
A recent Good Morning America segment introduced millions of viewers to bronchiectasis, a chronic lung condition that affects about 500,000 Americans.
Many people, including the woman interviewed, had never heard of it until diagnosis. What began as what she thought was pneumonia or a cold turned out to be a serious and progressive inflammatory disease that can cause ongoing coughing, shortness of breath, and fatigue.
What Is Bronchiectasis?
Bronchiectasis is a non-contagious chronic lung disease where the airways become widened and damaged, making it difficult to clear mucus. This creates a cycle of infection and inflammation that can worsen over time if untreated.
Because its symptoms often resemble asthma, COPD, or chronic bronchitis, many patients go years without a correct diagnosis.
Common symptoms include:
Because its symptoms often resemble asthma, COPD, or chronic bronchitis, many patients go years without a correct diagnosis.
Common symptoms include:
- Persistent cough with mucus
- Shortness of breath
- Fatigue or low energy
- Frequent chest infections
- Wheezing or crackling sounds in the lungs
Living with Bronchiectasis
“That tiredness, it’s like you really can’t do the things you want to do, even simple things around the house.”
The GMA story described how bronchiectasis impacts both daily life and emotional well-being. Weather changes, fatigue, and infections can limit social activities or even make leaving home difficult.
Over time, many people find that managing energy levels and incorporating airway clearance into daily routines becomes a key part of staying healthy.
The GMA story described how bronchiectasis impacts both daily life and emotional well-being. Weather changes, fatigue, and infections can limit social activities or even make leaving home difficult.
Over time, many people find that managing energy levels and incorporating airway clearance into daily routines becomes a key part of staying healthy.
The Importance of Early Diagnosis
One of the biggest takeaways from the Good Morning America feature is that bronchiectasis is often misdiagnosed or missed altogether.
If you experience a chronic cough lasting a long time, or two or more respiratory infections in a year, ask your doctor for a chest CT scan and referral to a pulmonologist.
Early diagnosis helps prevent further lung damage and allows for timely treatment, including antibiotics, airway clearance therapy, and lifestyle support.
If you experience a chronic cough lasting a long time, or two or more respiratory infections in a year, ask your doctor for a chest CT scan and referral to a pulmonologist.
Early diagnosis helps prevent further lung damage and allows for timely treatment, including antibiotics, airway clearance therapy, and lifestyle support.
Managing the Condition
There is currently no cure for bronchiectasis, but it can be managed successfully. A comprehensive plan may include:
- Airway clearance with devices such as an Aerobika® with a manometer or an AeroEclipse® XL nebulizer
- Nebulized medications to loosen mucus or reduce infection risk
- Exercise and pulmonary rehab to improve breathing
- Vaccinations and infection prevention strategies
- Hydration, nutrition, and stress management
Why Awareness Matters
Research organizations and sponsors such as Insmed are studying bronchiectasis and related infections like NTM (nontuberculous mycobacteria). Their work, combined with patient education and advocacy, is helping to change how this condition is recognized and treated.
Public awareness ensures that more patients receive proper testing and care before irreversible damage occurs.
Public awareness ensures that more patients receive proper testing and care before irreversible damage occurs.
Moving Forward
Bronchiectasis may be chronic, but it does not define those who live with it. Education, early detection, and community support are essential to improving quality of life.
Learn more about evidence-based strategies and resources at
BE CLEAR with Bronchiectasis
and watch step-by-step educational videos on the
BE CLEAR YouTube Channel.
To watch the Good Morning America segment click here.
Learn more about evidence-based strategies and resources at
BE CLEAR with Bronchiectasis
and watch step-by-step educational videos on the
BE CLEAR YouTube Channel.
To watch the Good Morning America segment click here.
During this Respiratory Care Week, the most important takeaway is that there is no single method that works for everyone when it comes to airway clearance.
Dr Colin Swenson and Dr Wendi Drummond podcast speakers on NTM lung disease and bronchiectasis
Each person living with bronchiectasis or other chronic lung conditions has unique needs, physical abilities, and comfort levels. What matters most is finding the combination of tools and techniques that help you breathe easier and stay consistent over time.
Airway Clearance Is Both Science and Art
All current bronchiectasis guidelines recommend working with a respiratory therapist to learn proper airway clearance techniques. These specialists can demonstrate breathing exercises, oscillating positive expiratory devices, and postural drainage positions that improve mucus clearance. But even with expert instruction, airway clearance remains as much an art as it is a science.
Consistency, timing, and creativity all play a role. Some people prefer short sessions throughout the day, while others set aside dedicated time morning and evening. The key is to listen to your body and notice what feels effective and sustainable.
Consistency, timing, and creativity all play a role. Some people prefer short sessions throughout the day, while others set aside dedicated time morning and evening. The key is to listen to your body and notice what feels effective and sustainable.
Personal Consultations Can Make a Difference
Many people find it helpful to schedule a consultation with me, Linda Esposito, to review their airway clearance routine. I demonstrate my own techniques and share the tools I use, then we talk about what you currently do and explore ways to make your routine more efficient and personalized.
Together, we can identify adjustments and additions for your airway clearance toolkit that help you clear mucus more effectively and with less stress.
Together, we can identify adjustments and additions for your airway clearance toolkit that help you clear mucus more effectively and with less stress.
Keep Learning and Keep Breathing
Respiratory Care Week is a reminder to appreciate the incredible professionals who help us breathe better and to keep improving our own self-care practices. Whether you are new to airway clearance or refining your long-time routine, remember that progress comes from learning, experimenting, and adapting.
Let’s keep learning together and continue building confidence in our daily airway clearance routines.
Have a listen to this podcast series featuring two podcasts on Airway Clearance!!
Click here, then scroll down to read more blogs!!
Let’s keep learning together and continue building confidence in our daily airway clearance routines.
Have a listen to this podcast series featuring two podcasts on Airway Clearance!!
Click here, then scroll down to read more blogs!!
Respiratory Care Week is here, and it’s the perfect time to highlight the vital role of respiratory therapists and the tools that help people breathe better every day.
Yesterday I shared a post about Monaghan Medical, the makers of the Aerobika® and the AeroEclipse® and Ombra nebulizing system. Today, we’re continuing the celebration with a “PEP talk”—or better yet, an OPEP talk!
What Is OPEP Therapy?
OPEP stands for Oscillating Positive Expiratory Pressure. This therapy uses a small handheld device to help loosen mucus and open partially blocked airways. As you exhale through the device, it creates gentle vibrations that “unstick” mucus, making it easier to cough out.
Two of the most popular OPEP devices are the Aerobika® and Acapella®. These tools are especially helpful for people living with bronchiectasis, COPD, cystic fibrosis, asthma, or other chronic lung conditions where mucus buildup is a daily challenge.
For a step-by-step demonstration, visit my YouTube Channel – Clearance of Airways Playlist where I show exactly how these devices work and how to use them safely.
Two of the most popular OPEP devices are the Aerobika® and Acapella®. These tools are especially helpful for people living with bronchiectasis, COPD, cystic fibrosis, asthma, or other chronic lung conditions where mucus buildup is a daily challenge.
For a step-by-step demonstration, visit my YouTube Channel – Clearance of Airways Playlist where I show exactly how these devices work and how to use them safely.
Finding the “Goldilocks Zone” with a Manometer
When it comes to OPEP, effort matters but more is not always better. Many people tend to blow too hard into their device, thinking it will move mucus faster. In reality, exhaling too forcefully can collapse smaller airways and reduce the effectiveness of airway clearance.
That’s where the manometer accessory comes in. A manometer measures the pressure created during exhalation so you can stay in the “Goldilocks zone”—not too hard, not too light, but just right.
If you use a manometer, your goal is to maintain a pressure between 10 and 20 cmH₂O throughout your exhalation. Staying within this range helps keep your smaller airways open and promotes optimal mucus movement.
Pressures above this range can actually work against you, while pressures below may not provide enough resistance to be effective.
That’s where the manometer accessory comes in. A manometer measures the pressure created during exhalation so you can stay in the “Goldilocks zone”—not too hard, not too light, but just right.
If you use a manometer, your goal is to maintain a pressure between 10 and 20 cmH₂O throughout your exhalation. Staying within this range helps keep your smaller airways open and promotes optimal mucus movement.
Pressures above this range can actually work against you, while pressures below may not provide enough resistance to be effective.
Why OPEP Devices Matter for Bronchiectasis and Beyond
For people with bronchiectasis and other mucus-producing lung diseases, airway clearance is a daily essential. OPEP devices make that process more effective and less exhausting.
Regular OPEP use can help:
Regular OPEP use can help:
- Reduce coughing fits and sputum buildup
- Prevent flare-ups and infections
- Improve breathing comfort and energy
- Support long-term lung function
Where to Purchase the Aerobika with Manometer
Purchasing an Aerobika® with a manometer usually costs only about $10 more than the Aerobika alone. You can order directly from Tampa Specialty Pharmacy, a trusted distributor of Monaghan Medical products.
OPEP therapy is one of the most empowering self-care tools for those living with chronic lung conditions. By learning proper technique and using the right accessories, you can make airway clearance more effective and comfortable—so you can focus on living, not just managing symptoms.
To learn more, explore my YouTube channel and BE CLEAR blog for additional videos, tips, and patient-friendly education.
BE CLEAR has a consulting relationship with Monaghan Medical.
Did you know that Respiratory Care Week was created by President Ronald Reagan?
After surviving an assassination attempt in 1981, he established this important week, now celebrated during the last full week of October, to honor respiratory care professionals for their dedication and expertise.
Recognizing the Experts Who Help Us Breathe Easier
Each October, we take time to recognize their skill and compassion. Unfortunately, many in the bronchiectasis community still do not have access to respiratory therapists for one-on-one guidance. Hopefully, as bronchiectasis centers continue to expand, that will change.
For now, we rely on education from companies in the lung health space like Monaghan Medical Corporation, maker of the Aerobika® and AeroEclipse® nebulizer. Their newly updated website is beautiful, informative, and easy to navigate: https://www.monaghanmed.com/
For now, we rely on education from companies in the lung health space like Monaghan Medical Corporation, maker of the Aerobika® and AeroEclipse® nebulizer. Their newly updated website is beautiful, informative, and easy to navigate: https://www.monaghanmed.com/
Reliable Products and Helpful Partners
No endless scrolling on the internet trying to figure out where to get our devices or how to use them.
Monaghan is also making it easier than ever to order devices like the Aerobika® with a manometer. You can now purchase it directly through Tampa Specialty Pharmacy (TSP).
Need a prescription? No problem. The Monaghan website includes a link to their online partner, OLA Digital Health, where you can quickly obtain one.
And here’s something I love: the Aerobika® is now available at Walmart pharmacies. That means if I’m traveling and accidentally leave mine behind (yes, it’s happened), I can simply pick one up at Walmart.
Monaghan is also making it easier than ever to order devices like the Aerobika® with a manometer. You can now purchase it directly through Tampa Specialty Pharmacy (TSP).
Need a prescription? No problem. The Monaghan website includes a link to their online partner, OLA Digital Health, where you can quickly obtain one.
And here’s something I love: the Aerobika® is now available at Walmart pharmacies. That means if I’m traveling and accidentally leave mine behind (yes, it’s happened), I can simply pick one up at Walmart.
A Company That Truly Cares
If you’ve contacted Monaghan’s Customer Service team, you already know how knowledgeable and responsive they are. They understand their products and genuinely care about keeping us informed and satisfied.
As a consultant for the company for years, I’ve had the privilege of visiting their immaculate upstate New York plant and speaking directly with the assembly line workers to let them know how vital their work is to our well-being.
Monaghan Medical continues to support our community in a big way, and that matters, because for many of us, it’s a lifelong relationship.
As a consultant for the company for years, I’ve had the privilege of visiting their immaculate upstate New York plant and speaking directly with the assembly line workers to let them know how vital their work is to our well-being.
Monaghan Medical continues to support our community in a big way, and that matters, because for many of us, it’s a lifelong relationship.
If you use airway clearance devices like the Aerobika® or the AeroEclipse® XL nebulizing cup, keeping them clean is one of the most important ways to protect your lungs and get the most out of your treatments.
These tools help open up your airways and create an inhospitable environment for bacteria and other pathogens. It's important to disinfect them regularly so they do not become a potential source of infection.
For people living with bronchiectasis, this step is especially important. Bacteria such as Pseudomonas aeruginosa and nontuberculous mycobacteria (NTM) can grow in moist environments and are difficult to treat once they take hold.
Regular cleaning and disinfecting of your Aerobika® and AeroEclipse® XL devices helps prevent contamination, protect your lungs, and keep your airway clearance routine safe and effective.
The good news is that caring for your equipment does not have to be complicated. Once you understand the steps and make them part of your daily routine, it becomes second nature, like brushing your teeth. Taking a few extra minutes to clean and sterilize your devices can make a lasting difference in your respiratory health and peace of mind.
I hope you find these easy-to-follow instructions helpful! Let me know in the comments below if you have any questions.
When I talk about being clear with bronchiectasis, I don’t just mean lung function.
I mean clarity in three essential areas:
- Clear lungs
- A mind free of misconceptions
- A spirit unburdened by fear
1. Keeping Your Lungs Clear with Bronchiectasis
Maintaining open, mucus-free airways is the foundation of bronchiectasis self-care. Daily airway clearance helps:
What to Include in an Airway Clearance Routine
For a deeper dive, explore my airway clearance Youtube playlist.
- Prevent infection
- Improve breathing capacity
- Support energy for everyday activities
What to Include in an Airway Clearance Routine
- Breathing techniques such as the Active Cycle of Breathing Technique (ACBT) or autogenic drainage
- Regular physical activity like walking, yoga, or pulmonary rehab
- Airway clearance devices such as Aerobika®, Acapella®, or chest wall oscillation vests
For a deeper dive, explore my airway clearance Youtube playlist.
2. Clearing Up Misconceptions About Bronchiectasis
Clear lungs are only part of the picture. We also need clear minds—free from misinformation. Unfortunately, inaccurate advice is common in online groups and social media. While personal stories can be comforting, they are not always based in science.
Where to Find Reliable Information
Where to Find Reliable Information
- Medical institutions: Mayo Clinic, Cleveland Clinic, National Jewish Health
- International organizations: EMBARC, Bronchiectasis and NTM Association
- Trusted resources: The Resources Page on this website where I share research, webinars, and patient education tools
3. Releasing Fear and Emotional Stress from Bronchiectasis
A bronchiectasis diagnosis often stirs strong emotions, including:
Strategies to Support Emotional Health
- Anger over delayed diagnosis or lung damage
- Frustration with daily treatments
- Grief over lifestyle changes
Strategies to Support Emotional Health
- Counseling or therapy for mental well-being
- Journaling to process thoughts and emotions
- Restorative practices such as yoga, meditation, or The Art of Jin Shin (which I personally use to restore balance)
Living Well by Being Clear in Body, Mind, and Spirit
When we commit to clarity in our lungs, mind, and spirit, we do more than manage bronchiectasis—we create conditions to thrive. By practicing daily airway clearance, choosing evidence-based knowledge, and tending to emotional well-being, we strengthen both our lungs and our overall quality of life.
Author
Linda 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.
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