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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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NTMTalk.com is a podcast dedicated to nontuberculous mycobacterial lung disease and bronchiectasis.  NTMTalk.com is a podcast dedicated to nontuberculous mycobacterial lung disease and bronchiectasis. Dr. Wendi Drummond, an infectious disease expert, and Dr. Colin Swenson, a pulmonologist, host it. Together, they aim to share accurate, practical, and approachable information for patients, loved ones, and healthcare providers.
What makes it especially enjoyable is their chemistry. A pulmonologist and an infectious disease doctor having thoughtful, honest conversations about bronchiectasis and NTM lung disease. Relatable and reassuring all at the same time. If you’re looking for something meaningful to listen to while walking, resting, or just taking a breath, this is it!! Let’s support this podcast program by sharing it with others. NTMTalk.com What is Bronchiectasis? Airway Clearance, an Interview with a Respiratory Therapist What is NTM? Diagnosis of NTM Lung Disease Treatment of MAC Lung Disease Arikayce, Clofazimine, and More Vest Therapy in Airway Clearance, an RT Interview Exacerbations of Bronchiectasis Mycobacterium abscessus The One About Sputum Dancing in the Rain (mental health) Reflux & Aspiration Hemoptysis, or the Bloody Cough Plus interviews with many of our favorite people and LOTS of questions answered!! Now a new season is underway. Here is Episode 1 of Season 3. Happy Listening‼️‼️ Linda Esposito 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. Why You Should AttendThis 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. Registration DetailsSign 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 Agenda for December 1, 20259:30 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 Need to Make Changes to Your Registration?Contact Marla Hymes at
[email protected] 212 263 5183 Reach out if:
#bronchiectasis #NTM  Two days at the First North American Bronchiectasis and NTM Conference!!
What a whirlwind! Two days filled with networking, smiles and a buzz of cooperation in the air. The biggest takeaway: progress is happening! While there are still no U.S. guidelines for bronchiectasis, we’re hopeful they’ll be released in the first quarter of 2025. Even more exciting, there will be Standards of Care established for the 150 designated care centers across the U.S. These guidelines will outline best practices, empowering us to advocate for proper care — whether it’s securing necessary nebulizing equipment or appropriate testing for swallowing and reflux. One promising development on the horizon: a potential blood test for NTM in the next few years. This could eliminate the stress of producing sputum samples — a huge relief for many of us! Though Dr. Chalmers (aka Dr. Bronchiectasis❤️) was in high demand, we managed to squeeze in a few moments for some fun social media pics. Helga from NTM Info & Research was also there, warmly welcoming everyone as they explored the booths featuring vest companies, Monaghan Medical, the Bronchiectasis and NTM Association, Insmed, Mannkind and other pharmaceutical companies working on treatments for BE and NTM. It was inspiring to see clinicians, industry leaders, pharma companies and people living with bronchiectasis all coming together with a shared purpose. Progress is being made and the future looks brighter! Today I’m focusing on self-care, including my annual physical. Then I’ll be heading to a luncheon sponsored by National Jewish Health. Dr. Chuck Daley (aka Dr. NTM❤️) will be our guest speaker. I’ll be reporting back!!!  I wanted nothing more than to go to Scotland this past July for the World Bronchiectasis Conference. Unfortunately, it conflicted with my family reunion, so I relied on Judy Schloss, the clinical manager at Monaghan Medical, to send me photos. More than anything, I wanted to visit my hero, Dr. James Chalmers’ laboratory. For me, it would’ve been like seeing the Batcave! You might think I’m exaggerating, but Dr. Chalmers (aka Dr. Bronchiectasis) actually led a proof-of-concept trial called BATMAN (Bronchiectasis Alpha-1 Augmentation Trial). Dr. Chalmers has been our advocate from the very beginning. Even when he was told that bronchiectasis research was a dead end, he persisted. In a recent video, he shared this powerful message: “The greatest unmet need for bronchiectasis, from my point of view as a clinician caring for these patients, is to have better, more effective treatments for the disease. Unfortunately, around 50% of patients with bronchiectasis, according to registry data, experience two or more exacerbations per year. The quality of life of our patients and their symptoms, the scores that they get on questionnaires, show that the impairment caused by this disease is as bad or worse than other respiratory conditions like COPD, asthma, or cystic fibrosis. So, patients are really suffering with frequent exacerbations and bad symptoms, but there are not enough effective treatments that patients can use. Most patients are reliant on physiotherapy and antibiotics, which relieve some of the symptoms but don’t modify the course of the disease and don’t prevent these exacerbations or improve these symptoms. So we urgently need better treatments, and that means that we need investment into clinical trials and also into translational science in order to understand the disease better, find better treatment targets, and help us to develop those new therapies.” In the fight against bronchiectasis, Dr. Chalmers reminds us that real superheroes don’t wear capes—they wear lab coats. |
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
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