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There is growing excitement in the bronchiectasis community around new medications that may help reduce inflammation and slow disease progression.  Two of the most talked about therapies right now are brensocatib (BRINSUPRI®) and verducatib. These medications represent a new class of treatment known as DPP1 inhibitors, designed to target inflammation at its source. At the same time, it is important to understand how these medications work, who they may help, and what options exist if they are not accessible. How Brensocatib Works and What to Expect During a recent patient webinar, Prof. James Chalmers from the University of Oxford shared important insights about brensocatib. It Does Not Work Instantly One key takeaway is that brensocatib does not provide immediate results. It typically takes about four weeks to begin having an effect. This is because the medication works at the level of the bone marrow. It influences inflammatory cells before they enter the bloodstream. Those cells then travel to the lungs, which takes time. Understanding this timeline can help set realistic expectations when starting the medication. Early Patient Experience Some early patient reports have been encouraging. One individual shared: “I’ve been on it for almost two months. I feel like a normal person for the first time in four years. No side effects. I’ve been on 25 milligrams since September. No wheezing or chest congestion anymore. I still cough, but there is less in my lungs.” Of course, not every experience has been entirely positive. Some individuals have reported side effects, including skin changes. As with any new medication, responses can vary from person to person. What We Still Do Not Know Even with FDA approval of brensocatib for non-cystic fibrosis bronchiectasis, several important questions remain.
Verducatib and the AIRTIVITY™ Clinical Trial If brensocatib is not available or affordable, another option to explore is the AIRTIVITY™ clinical trial studying verducatib. Verducatib is a similar DPP1 inhibitor and is currently being studied worldwide. Clinical trials like this are essential for:
An Established Option: Azithromycin Prophylaxis While new therapies are emerging, existing treatments remain an important part of care. During a recent support group discussion, Dr. Ed Chan a researcher at National Jewish Health, in Denver, Colorado, emphasized the continued role of azithromycin. Why Azithromycin Is Used Azithromycin is often prescribed on a regular basis, such as weekly or several times per week, to:
Important Safety Consideration: NTM Monitoring Long-term azithromycin use requires careful monitoring. Patients should be regularly tested for nontuberculous mycobacterial infections. Why This Matters If an NTM infection develops:
Balancing Hope with Reality There is real momentum in bronchiectasis research, and that brings hope. At the same time, not everyone has access to newer therapies yet. It is important to:
Looking Ahead
Medications like brensocatib and verducatib represent an exciting step forward in bronchiectasis care. At the same time, established therapies such as azithromycin remain valuable tools. The future of bronchiectasis treatment will likely involve a combination of:
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Have you tried everything to get rid of reflux and still no luck? I think I may be able to help.  It can be incredibly frustrating when you’ve done all the right things. You’ve seen specialists, had testing, adjusted your diet, and maybe even elevated the head of your bed. And yet, the symptoms remain. A drippy nose, hoarseness, sore throat, or that persistent feeling that something is stuck in your throat. And it’s not just about the reflux. For those of us living with bronchiectasis, there is also the concern about how reflux, both acid and non-acid, may be contributing to disease progression. That uncertainty can create real anxiety. Let’s walk through a few commonly overlooked factors that may be playing a role: The Connection Between Reflux and Bronchiectasis Reflux is not always straightforward. While many people think only about acid reflux, non-acid reflux can also contribute to symptoms and may be harder to detect. In bronchiectasis, reflux can potentially:
Overlooked Triggers That May Be Worsening Your Reflux 1. Are You Using Albuterol Before Airway Clearance? Albuterol can be very helpful for opening the airways. For some people, it is an essential part of their routine. However, it is not always necessary for everyone. Because it relaxes smooth muscle, it may also relax the lower esophageal sphincter. This can allow stomach contents to move upward, contributing to reflux symptoms. You might consider asking during your next pulmonary function test if your breathing can be evaluated with and without albuterol. If it does not make a meaningful difference, it may be worth discussing whether you need it. 2. Are You Staying in Tight Clothing After Exercise? This is easy to overlook. Tight clothing, including workout wear, can increase pressure between the abdomen and chest. That pressure can contribute to reflux. A simple change into looser clothing after exercise may help reduce symptoms. 3. Are You Bending at the Waist Throughout the Day? Even if you avoid eating late and elevate your bed, daytime habits matter. Activities like:
Try bending at the knees or hinging at the hips instead. 4. Could Your Supplements Be Contributing? This is a big one that is often missed. Some supplements, especially those with acidic components such as ascorbic acid (vitamin C), can trigger reflux symptoms in certain individuals. In addition, it may not be just one supplement. It could be:
5. Are You Drinking Carbonated Beverages? Carbonated drinks, including sparkling waters like LaCroix, Pellegrino, and Topo Chico, can increase stomach pressure. As much as many of us enjoy them, they may worsen reflux symptoms and are worth limiting. 6. How Is Your Stress Level? A certain amount of stress is part of life. In fact, it helps motivate us. But chronic stress can impact gut function and worsen reflux symptoms. Incorporating stress management practices, even small ones, can make a meaningful difference over time. Why Reflux Can Feel So Hard to Control One of the most challenging aspects of reflux is that it is often not caused by just one factor. It is usually a combination of:
A Gentle Reminder
If you are dealing with ongoing reflux, you are not alone. Sometimes it is not about finding one perfect solution. It is about identifying several small factors that, when adjusted, can collectively make a difference And as always, any changes should be discussed with your medical team. Research Opportunity - Mab Biobank for Phage Therapy Development  Tolka AI Therapeutics is building a biobank specifically for Mycobacterium abscessus to advance personalized bacteriophage therapy research. This IRB-approved study (BRANY#25-08-468-1945) aims to collect Mab isolates that could lead to personalized treatment options.
What We're Doing: We're collecting sputum samples from Mab patients to isolate bacteria for phage discovery. If we find active phages against your specific Mab strain, you could potentially access personalized phage therapy through future clinical trials or expanded access programs. Participation Details: ● Two sputum samples collected at home ● All materials and shipping provided (no cost) ● Brief medical history questionnaire ● Optional monthly QOL-B surveys You're Eligible If: ● 18+ years old ● Live in the US ● Have Mab documented from respiratory specimens ● Can safely produce sputum This is a unique opportunity to contribute to research that could directly benefit you and the broader M abscessus community. Sign up or learn more: tolka.ai/biobank Questions: [email protected] If you live outside the United States, this bronchiectasis conference hosted by the European Lung Foundation was made for you.  To our dear overseas Bronchi-family… get ready for one of the best conferences of the year! I know there have been several bronchiectasis webinars held in the United States that were not always convenient for those of you living in other parts of the world. This upcoming conference, on March 21, 10:00-16:00 CET, however, is one you will definitely want to sign up for. One thing I absolutely love about it is that translation services will be available, so hopefully you will be able to listen in your own language.   Click to SIGN UP NOW!!!
The Bronchiectasis and NTM Association has accepted 25 new Care Centers into the Bronchiectasis and NTM Care Center Network (CCN). These eight Care Centers and 17 Clinical Associate Center sites in 14 states, added to the previously approved 33 Centers, bring the current total to 58 centers across the United States.  The CCN aims to facilitate access to specialized care and support for the hundreds of thousands of people with bronchiectasis and nontuberculous mycobacterial (NTM) lung disease.
“The prevalence of bronchiectasis and NTM lung disease continues to increase. Patients deserve access to high-quality, specialized care and resources,” said Doreen Addrizzo-Harris, M.D., Chair of the CCN Steering Committee. “The CCN’s innovative, nation-wide network will help us enhance care and improve quality of life for those living with these conditions, as well as accelerate progress toward a cure.” Centers accepted into the CCN receive a designation of either a Bronchiectasis and NTM Care Center or a Bronchiectasis and NTM Clinical Associate Center, based on institutional resources and infrastructure. The requirements are established by the CCN’s Steering Committee, comprised of leading experts in the field. The new Bronchiectasis and NTM Care Center sites are: The new Bronchiectasis and NTM Clinical Associate Center sites are: Why This Expansion Is Encouraging For many people living with bronchiectasis, finding knowledgeable clinicians can be challenging. The expansion of the Care Center Network means that more patients across the United States may gain access to specialized care and coordinated treatment teams. These centers bring together pulmonologists, infectious disease specialists, respiratory therapists, dietitians, and other professionals experienced in managing bronchiectasis and NTM lung disease. As the network continues to grow, will help improve diagnosis, treatment, and quality of life for the hundreds of thousands of people living with these conditions. Interested in the thirty-three previously approved bronchiectasis and NTM Centers? Or, go to the Bronchiectasis and NTM Association’s Care Center Network page to find a center by location and zip code. When I was first diagnosed with bronchiectasis, one of the most confusing parts of the journey was figuring out who should be managing my care. Should I see a pulmonologist? An infectious disease specialist? A respiratory therapist?  Over time, I realized something important: bronchiectasis is a complex condition that often requires a team of experts working together. Fortunately, in the U.S., this type of coordinated care is becoming more common. The Bronchiectasis & NTM Association has created a Care Center Network designed specifically to support people living with bronchiectasis and nontuberculous mycobacterial (NTM) lung disease. These specialized centers bring together clinicians with expertise in diagnosing and managing these conditions. The goal is simple but important: reduce the time to diagnosis and provide comprehensive, high-quality care. What Is a Bronchiectasis Care Center? A bronchiectasis care center is a specialized medical program where multiple healthcare professionals collaborate to diagnose and manage bronchiectasis and nontuberculous mycobacterial (NTM) lung disease. These centers typically include pulmonologists, infectious disease specialists, respiratory therapists, dietitians, pharmacists, and mental health professionals who work together to provide coordinated, comprehensive care for patients. Why Specialized Bronchiectasis Care Is Important Bronchiectasis and NTM infections are being diagnosed more frequently worldwide. Yet many patients still experience long delays before receiving an accurate diagnosis or appropriate treatment. Patient surveys have shown that many individuals feel their care is fragmented and that support services are limited. Other complex medical conditions have demonstrated that multidisciplinary care improves outcomes. Diseases such as cystic fibrosis, HIV, and cancer are often treated in specialized centers where multiple experts collaborate to manage all aspects of the disease. Bronchiectasis care centers are built on a similar model. What Patients Should Expect From a Bronchiectasis Care Center A bronchiectasis care center focuses on coordinated, patient-centered care. While each center may operate differently, most share several key features. Patients can generally expect:
More specific services will include: Education and ongoing monitoring Care centers often provide follow-up appointments and patient education between visits. Access to additional specialists when needed Patients may be referred to experts such as dietitians, mental health professionals, or pulmonary rehabilitation programs. The Bronchiectasis Care Team Because bronchiectasis affects many aspects of health, care centers rely on a multidisciplinary team of specialists. Pulmonologists and Infectious Disease Specialists Pulmonologists focus on lung structure and airway disease, while infectious disease physicians evaluate bacteria identified in sputum cultures and determine whether treatment is necessary. Collaboration between these specialists is often essential when managing bronchiectasis and NTM infections. Program Coordinator Many care centers include a program coordinator, often a nurse, who serves as the main point of contact for patients. This person may help coordinate testing, obtain medical records, communicate with providers, and assist patients with navigating their care. Respiratory Therapy and Airway Clearance Airway clearance is a cornerstone of bronchiectasis treatment. Respiratory therapists teach techniques to help patients clear mucus from their lungs and guide them in using airway clearance devices such as nebulizers, positive expiratory pressure devices, and chest oscillation vests. Nutrition Support Bronchiectasis can sometimes affect appetite and digestion. Some patients experience reflux, reduced appetite, or unintended weight loss. Maintaining adequate nutrition is important for lung health, and dietitians can help patients develop individualized nutrition plans. Mental Health and Social Support Living with a chronic lung disease can affect emotional well-being. Anxiety and depression are common among patients with bronchiectasis. Mental health professionals and social workers can help patients address emotional challenges, navigate healthcare systems, and connect with supportive resources. Additional Specialists Involved in Bronchiectasis Care Because bronchiectasis can be associated with other conditions, additional specialists may become involved in care. These may include: • gastroenterologists for reflux and digestive issues • ear, nose, and throat specialists • allergists and immunologists • genetic counselors • thoracic surgeons For example, gastroesophageal reflux disease (GERD) is common in bronchiectasis and may worsen lung symptoms. How to Find a Bronchiectasis Care Center If you are interested in receiving care at a specialized center, the Bronchiectasis & NTM Association maintains a Care Center Network across the United States. Even if most of your care is provided locally, many patients benefit from periodic consultations with specialists at these centers, who can help guide treatment decisions. Frequently Asked Questions Do I need to go to a bronchiectasis care center? Not everyone needs to receive all of their care at a specialized center. However, many patients benefit from at least one consultation with clinicians who have expertise in bronchiectasis and NTM lung disease. Can I still see my local doctor? Yes. Many patients continue to work with their local pulmonologist or primary care physician while also consulting with a specialized center. This collaborative approach helps ensure continuity of care. What specialists treat bronchiectasis? Bronchiectasis care often involves a team that may include pulmonologists, infectious disease specialists, respiratory therapists, dietitians, pharmacists, mental health professionals, and social workers. Why is airway clearance important? Airway clearance helps remove mucus from the lungs, reducing infections and improving breathing. Respiratory therapists often teach patients how to perform these techniques and use airway clearance devices effectively. These are encouraging times Bronchiectasis and NTM lung disease are complex conditions, but patients should not have to manage them alone. Specialized bronchiectasis care centers represent an important step toward improving diagnosis, treatment, and long-term outcomes. By bringing together pulmonologists, infectious disease specialists, respiratory therapists, dietitians, and other professionals, these centers provide comprehensive, patient-centered care that can make a meaningful difference for people living with bronchiectasis. After several years, I finally cleared a Mycobacterium avium complex (MAC) infection. It was a long journey that required patience, consistency, and a deep commitment to my health.  What Is Mycobacterium Avium Complex (MAC)?MAC is a type of nontuberculous mycobacterial (NTM) lung infection. It often occurs in people with bronchiectasis. Bronchiectasis (BE) can cause mucus to build up in the airways, creating an environment where bacteria are more likely to grow and persist. However, it is not always clear which came first. Did the bronchiectasis create the conditions for the infection, or did the infection contribute to airway damage and cause the BE? In some cases, it truly can be a “chicken or the egg” situation. Symptoms Can Vary WidelyPeople experience MAC very differently. Some individuals struggle with symptoms such as night sweats, debilitating fatigue, chronic cough, and daily sputum production. Others may have very few symptoms and feel relatively well even while the infection is present. Because symptoms and disease severity can vary widely, treatment decisions are often individualized and difficult to make. When Antibiotics Are Recommended for MACWhen my infection was first diagnosed, my doctor recommended antibiotic therapy. Standard treatment for MAC often involves several antibiotics taken for a long time — often over a year. Choosing a Different Initial ApproachIn my case, after careful discussion with my physician, I initially chose a different approach. As an experienced health coach, I decided to focus on myself as my only client and see whether I could clear the infection without starting antibiotics right away. I committed to what I called building a brick house. Rather than relying on one single intervention, I focused on laying one brick at a time through consistent airway clearance, regular exercise and movement, and healthy lifestyle practices, including stress management and reflux control. At the same time, I continued to monitor my condition closely with my medical team and understood that antibiotics remained an option if my condition worsened. A Long but Meaningful JourneyIt was not a quick or easy process. But after several years, my cultures finally cleared. My experience is not meant to suggest that everyone can or should follow the same path. Many people with MAC absolutely require antibiotic treatment, particularly those with cavitary disease or who are very symptomatic. This decision should always be made with a physician who is well-trained in bronchiectasis and Non-tuberculous Mycobacteria lung diseases, such as MAC. But my journey is a reminder that there can sometimes be more than one path forward. Steady, consistent care of our lungs and overall health can make a meaningful difference over time. For me, the process of building that brick house, one daily habit at a time, became the foundation for protecting my lungs and supporting my long-term health. *Common Questions About MAC Lung Disease*How long does it take to clear a MAC infection? MAC infections can take a long time to treat or resolve. When antibiotics are used, treatment often lasts at least 12 months after cultures become negative. If cultures are not converting by six months, the protocol is often changed to daily medication rather than three times a week, and an inhaled antibiotic might be added. Do all people with MAC infection need antibiotics? Not always. Some people with mild symptoms and no cavitary disease may opt for "watchful waiting" and be monitored closely before starting treatment. Others, particularly those with more severe disease or significant symptoms, may benefit from antibiotic therapy. Decisions about treatment should always be made with a pulmologist and/or infectious disease doctor who specializes in bronchiectasis and MAC lung disease. Can lifestyle habits help support lung health with MAC or bronchiectasis? Absolutely! While lifestyle practices are not a cure for bronchiectasis and chronic lung infections, consistent habits such as airway clearance, exercise, stress reduction, reflux management, and good sleep can play an important role in supporting lung health and overall well-being.
My story and the practices I used to build a stronger and more resilient body are discussed in my book, The BE CLEAR Method to Living with Bronchectasis, available on Amazon. This post is for educational purposes only. It reflects my personal experience and should not be considered medical advice. Never change your treatment plan without discussing it with your medical team. |
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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