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I switched to the Ombra compressor nebulizing system after noticing that it was consistently prescribed at National Jewish Health, one of the world’s leading lung hospitals.  When working with clients, I often demonstrate my own airway clearance routine but always recommend consulting a respiratory professional whenever possible. Unfortunately, many people don’t have access to specialized care in their communities and must rely on manufacturer inserts, online videos, and our education sessions together.
Dr. Charles Daley, a world-renowned expert on bronchiectasis and NTM disease, recently said: “The cornerstone of therapy is what is termed airway clearance. Part of the pathophysiology of bronchiectasis is the airways produce too much mucus. The airways get plugged up. That makes people cough, it makes their pulmonary function worsen, and also their risk for infection increase. So airway clearance, and when we when we talk about that, there are several ways we can improve airway clearance. We can give someone what are called Oscillating PEP valves. These are handheld devices that you breathe (into), and it causes some vibration in the airwaves. It causes some back pressure, and that helps open the airways and shear the thicker mucus, so so the patient can get it out. My favorite is the Aerobika used in tandem with the Aeroeclipse nebulizing cup. There are other things we can do. We can give them inhaled hypertonic saline, which can thin the mucus. Vests are (what) people wear that also vibrate and can help break up the mucus. So there’s different approaches. In the exact way we do it varies from patient to patient. One may be on one of those, one may be on all of those.” Let’s remember airway clearance isn’t one-size-fits-all—it requires the right tools and techniques for each person. When specialized care isn’t available, education and the right resources empower people to take charge of their lung health. www.letsbecleartoday.com BE CLEAR has a consulting relationship with Monaghan Medical
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Thirty-three U.S. centers join the new Bronchiectasis and NTM Care Center Network facilitating access to high-quality, specialized patient care for bronchiectasis and NTM lung disease.  Miami (March 12, 2025) – The Bronchiectasis and NTM Association has accepted 27 Care Center and six Clinical Associate Center sites in 23 states and the District of Columbia into the new Bronchiectasis and NTM Care Center Network (CCN).
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. “As the prevalence of bronchiectasis and NTM lung disease grows, it is even more important for us to create this Care Center Network to improve access to high-quality, specialty care and resources patients need,” said Doreen Addrizzo-Harris, M.D., Chair of the CCN Steering Committee. “The CCN’s innovative, nationwide network will help us achieve our goals of improving care and quality of life for those with these conditions, as well as advancing 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 network will span 150 medical centers in diverse geographical locations nationwide over the next three years. The Bronchiectasis and NTM Care Center Network is generously supported by Insmed Incorporated as a Founding Sponsor and Boehringer Ingelheim. For more information about the Bronchiectasis and NTM Care Center Network, visit www.bronchandntm.org. #bronchiectasiscarecenters #NTMCare #COPDFoundation Let’s Talk Morning Routines! These are my top 3 products I use every morning. I thought I’d made a quick video to show you how and why they are my favorites! www.refluxraft.com/?utm_source=lindaesposito&utm_medium=social&utm_campaign=affiliate
💡 A Simple Tool to Help Manage Reflux and Protect Your Lungs Did you know that reflux and aspiration can contribute to worsening lung conditions like bronchiectasis? That’s why managing reflux is such an important part of my daily routine. One product I’ve added to my Reflux Tool Kit is RefluxRaft. It forms a protective raft-like barrier on top of stomach contents, helping to reduce acid reflux—especially after meals and while lying down. I personally use RefluxRaft after breakfast and before bed to help minimize the chance of aspiration into the lungs, which is a known risk factor for lung inflammation and damage in people with bronchiectasis. ✨ It’s become an essential part of my Reflux Tool Kit! 🔗 Click here to learn more about RefluxRaft and how alginate therapy works to reduce reflux and support both digestive and respiratory health. ‼️ Important Note: As always, please consult your healthcare provider before making changes to your current care routine. 🤝 BE CLEAR with Bronchiectasis, LLC is proud to collaborate with RefluxRaft. #refluxraft #acidrefluxrelief #guthealth #alginatetherapy #refluxsupport #COPD Traveling with Bronchiectasis: How I Minimize MAC Exposure from Water When I travel, I take extra precautions to reduce my risk of exposure to Mycobacterium avium complex (MAC).  Mycobacterium avium complex (MAC)—are a group of bacteria commonly found in water and soil that can be inhaled or aspirated into the lungs.
To stay safe, I either:
The answer lies in two common mechanisms:
We all occasionally micro-aspirate fluids—especially when something “goes down the wrong pipe.” For most healthy people, the lungs can clear these small amounts without issue. But for those of us with bronchiectasis, compromised mucociliary clearance makes it harder to remove aspirated material, which can lead to inflammation and chronic infection. Another risk factor is gastric reflux. Both acid and non-acid reflux can move from the stomach up into the esophagus and airways—especially during sleep. If this reflux contains MAC bacteria from drinking water that wasn’t neutralized by stomach acid, the lungs may be vulnerable to colonization. GERD Precautions to Lower Aspiration Risk If you’re managing GERD or concerned about silent reflux, here are some practical tips that may help:
To lower my exposure to environmental MAC bacteria, I avoid:
🧬 According to Dr. Joseph Falkinham, a leading microbiologist and expert on NTM exposure, “MAC thrives in biofilms in household water systems and is resistant to chlorine disinfection.” Finding Balance in Prevention Some bronchiectasis and MAC specialists take a more relaxed view on environmental exposure, suggesting patients avoid “bacteria fixation” and focus on quality of life. Others recommend more proactive strategies, especially for patients with recurrent infections or risk factors like GERD. Your care should be tailored. Talk to your pulmonologist or infectious disease specialist about what’s best for your health and lifestyle. 🩺 Find support: NTM Info & Research – Find a Doctor 💙 A Reminder Bronchiectasis is a lifelong condition, but it doesn’t mean you need to overhaul everything at once. Even small steps—like changing your water source or elevating your bed—can make a meaningful difference in reducing risk and preserving lung health. 📌 Helpful Resources: 🚫 What to Avoid:
💡 Pro Tips:
 Save the date! Join Bronchiectasis/NTM Info & Research and Running on Air for an insightful webinar with Professor James Chalmers on the latest updates from the European Bronchiectasis Workshop & Forum on Respiratory Tract Infections. Meet Prof. James D. Chalmers: A Leading Authority on Bronchiectasis When it comes to advancing bronchiectasis care, few names are as influential as Professor James D. Chalmers. As the Asthma and Lung UK Chair of Respiratory Research at the University of Dundee, Prof. Chalmers has dedicated his career to improving outcomes for individuals living with bronchiectasis. He is best known for his leadership in the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC), an international research network that has transformed our understanding of bronchiectasis, and for serving as Chief Editor of the European Respiratory Journal. With over 350 peer-reviewed publications, Prof. Chalmers has made critical contributions to our understanding of the pathophysiology, diagnosis, and treatment of bronchiectasis. He is a key author of the European Respiratory Society (ERS) guidelines for the management of adult bronchiectasis, which offer clinicians trusted, evidence-based recommendations for bronchiectasis care. Professor Chalmers' Contribution to the Aspen Study Chalmers' groundbreaking work includes leading innovative clinical trials such as the ASPEN study involving Brensocatib, a potential first-in-class therapy targeting neutrophilic inflammation. For details on this trial, see the clinical trial registry entry for Brensocatib (NCT04594369). These studies are helping pave the way for precision medicine in bronchiectasis. Contribution to International Guidelines and Standards of Care Prof. Chalmers has also chaired and contributed to major international guidelines, including the 2017 ERS guidelines and the latest European Lung Foundation bronchiectasis management recommendations. His efforts continue to standardize care and improve quality of life for bronchiectasis patients around the world. Thanks to experts like Prof. Chalmers, the future of bronchiectasis care is looking brighter—with innovative therapies, patient-centered guidelines, and individualized treatment strategies leading the way. #Bronchiectasis Awareness #BronchiectasisResearch #JamesChalmers #ERSGuidelines #PrecisionMedicine #Brensocatib #RespiratoryHealth ✨Date: February 27 2025 ✨Time: 1 PM EDT Bacteriophages, or phages, are viruses that specifically target and destroy bacteria. These microscopic entities outnumber all other organisms on Earth and thrive in diverse environments, including ponds, lakes, and oceans.  Phages exhibit a unique structure, often resembling tiny robotic explorers with a 20-sided head mounted on a tail equipped with leg-like fibers. This design enables them to attach to specific bacterial hosts, inject their genetic material, and hijack the bacterium’s machinery to produce new phages, ultimately leading to the destruction of the bacterial cell. (Microbe Notes – Bacteriophage Structure & Function) A Brief History of Phage Therapy The discovery of bacteriophages dates back to 1915 when British bacteriologist Frederick Twort observed their antibacterial properties. Two years later, Félix d’Hérelle independently identified these viruses and recognized their potential as antibacterial agents. D’Hérelle pioneered phage therapy, establishing treatment centers across Eastern Europe. However, the advent of antibiotics—particularly penicillin, discovered by Alexander Fleming in 1928—led to a decline in the popularity of phage therapy in Western medicine. (ScienceDirect – History of Phage Therapy) The Resurgence of Phage Therapy Amid Antibiotic Resistance With the alarming rise of antibiotic-resistant bacteria, phage therapy is experiencing a renaissance. Phages offer a targeted approach to combating bacterial infections, especially those resistant to conventional antibiotics. Unlike broad-spectrum antibiotics, phages can be tailored to attack specific bacterial strains, reducing collateral damage to beneficial microbiota and minimizing the risk of resistance development. (ScienceDirect – Phage Therapy and Antibiotic Resistance) Recent Advances: Armata Pharmaceuticals’ AP-PA02 A notable advancement in phage therapy is the development of AP-PA02 by Armata Pharmaceuticals. This inhaled bacteriophage therapy targets Pseudomonas aeruginosa infections in patients with non-cystic fibrosis bronchiectasis. The Phase 2 Tailwind study demonstrated that AP-PA02 was well-tolerated and showed potential in reducing reliance on chronic antibiotics. Encouraged by these results, Armata is progressing toward a Phase 3 clinical trial, marking a significant step forward in the application of phage therapy for respiratory infections. (PR Newswire – Tailwind Study Results) The Future of Phage Therapy The renewed interest in phage therapy underscores its potential as a viable alternative or adjunct to antibiotics. As research advances, phage therapy may play a crucial role in personalized medicine, offering targeted treatments for bacterial infections that are unresponsive to traditional antibiotics. Continued clinical trials and regulatory support will be essential to integrating phage therapy into mainstream medical practice. (Journal of Intensive Care – Current Status of Phage Therapy) #PhageTherapy #Bacteriophage #Bronchiectasis #Phage #Pseudomonas #Biologic FDA Grants Priority Review to Brensocatib: A Potential Breakthrough for Bronchiectasis Treatment  On February 6, 2025, the U.S. Food and Drug Administration (FDA) accepted Insmed Incorporated’s New Drug Application (NDA) for brensocatib, granting it Priority Review status.This designation accelerates the regulatory timeline, setting a target PDUFA action date of August 12, 2025, under the Prescription Drug User Fee Act (PDUFA). Brensocatib: A First-in-Class DPP1 Inhibitor Brensocatib is an oral, reversible inhibitor of dipeptidyl peptidase 1 (DPP1), an enzyme responsible for activating neutrophil serine proteases (NSPs) such as neutrophil elastase. By blocking DPP1, brensocatib aims to reduce NSP activity, which in turn may help decrease inflammation and tissue damage in the lungs. Addressing an Unmet Need in Bronchiectasis Non-cystic fibrosis bronchiectasis is a chronic lung disease marked by permanent airway dilation, frequent infections, and excessive inflammation. Despite its rising prevalence—affecting over 500,000 people in the U.S.--there are currently no FDA-approved treatments specifically for this condition. Brensocatib has the potential to:
Promising Results from the ASPEN Study The NDA submission is backed by data from the Phase 3 ASPEN study—the largest clinical trial ever conducted in patients with bronchiectasis. The study showed that both 10 mg and 25 mg doses of brensocatib significantly reduced the annualized rate of pulmonary exacerbations compared to placebo over a 52-week period. 📄 View Insmed’s ASPEN Study press release. Brensocatib also demonstrated consistent benefits across diverse patient subgroups, suggesting wide applicability. Looking Ahead With FDA Priority Review, brensocatib could soon offer a long-awaited, disease-modifying treatment for patients living with non-cystic fibrosis bronchiectasis. If approved by August 2025, it would mark a major advancement in care, offering hope to those affected by this underrecognized and difficult-to-treat condition. 🧠 Learn more about brensocatib’s mechanism and development on ClinicalTrials.gov. #Brensocatib #Bronchiectasis #FDAReview #DPP1Inhibitor #PulmonaryHealth #Insmed #ASPENStudy Biologics are therapies made from living organisms or their components—such as proteins, cells, or bacteria.  Unlike traditional drugs made through chemical synthesis, biologics are developed using biotechnology. This allows them to target disease processes more precisely, often resulting in better outcomes and fewer side effects for certain conditions.
🧬 Learn more about how biologics are made and approved from the U.S. Food and Drug Administration (FDA). You’ve Probably Already Had a Biologic If you’ve received a vaccine, you’ve already experienced a biologic therapy in action. Vaccines for:
A Personal Note: How the HPV Vaccine Changed My Perspective More than 25 years ago, I had a hysterectomy following a diagnosis of cervical carcinoma in situ caused by HPV. At that time, the HPV vaccine didn’t exist. Today, it gives me peace of mind knowing that my grandchildren are protected against this cancer-causing virus, thanks to the development of preventive biologics. 📖 Read more about the HPV vaccine’s role in cancer prevention from the National Cancer Institute. Biologics in Chronic Illness Care Biologics aren’t just for disease prevention—they’re also used to treat a variety of chronic inflammatory and autoimmune conditions, including:
Are Biologics Being Studied for Bronchiectasis? Yes—and that’s where it gets exciting. While no biologics are currently FDA-approved specifically for bronchiectasis, researchers are exploring their potential role in managing bronchiectasis with asthma, allergies, or eosinophilic inflammation—a common combination in clinical practice. Biologics currently being studied or used for off-label treatments have shown promising results in small studies and case reports involving: Patients with these conditions may experience:
While biologics are powerful, they’re also extensively tested. As with any treatment, side effects are possible—but today’s biologics are held to high safety standards. In fact, biologics are often used when standard treatments fail or when precision is needed to avoid broader immune suppression. Biologics Are Already Changing Lives From vaccines to advanced immune therapies, biologics are transforming how we prevent, treat, and manage disease. And while they may sound “new” or “intimidating,” they’ve been part of mainstream medicine for decades—and they’re only getting better. If you live with bronchiectasis, asthma, or a chronic inflammatory condition, biologics may be an option worth discussing with your care team—especially if standard therapies aren’t enough. #BiologicsExplained #BronchiectasisCare #FutureOfMedicine #AsthmaOverlap #ChronicInflammation  I used to think I was eating healthy—until I got diagnosed.
Pasta and veggies. Rice and veggies. Potatoes and veggies. That was my go-to. But after my bronchiectasis and MAC diagnosis, I learned the hard way that protein is critical when dealing with inflammation and infection. Those days of carb-heavy meals? They’re long gone. One of my biggest lessons came from Michelle MacDonald, a nutritionist at National Jewish Health. In a webinar series sponsored by Bronchiectasis and NTM Info & Research, Michelle emphasized not only the importance of protein but also the need for a well-balanced diet—including protein, carbs, and fats—with a special focus on getting enough calories. 💥The Power of Protein💥 According to Michelle, protein should anchor every meal. And no, that doesn’t mean tossing a handful of garbanzo beans into your stir-fry. It means making a deliberate effort to get 20–30 grams per meal. Personally, I aim for the high 20s, four times a day. I think of protein as “spackle”—filling in the damage caused by inflammation and infection. I truly believe this was one of the key reasons I was able to clear a MAC infection without antibiotics—my body had what it needed to repair and rebuild. 💥Don’t Forget Carbs & Fats💥 While protein is essential, carbs and fats also play a crucial role in immunity and energy. If you’re not consuming enough, your body will start using protein for fuel instead—wasting it on energy instead of healing. 💥Trying to Gain Weight? Be Smart About Fiber💥 If you struggle with appetite or need to gain weight, Michelle recommends limiting fiber from fresh fruits, raw vegetables, and whole grains. These foods fill you up too quickly, so don’t make salads your main course! At the end of the day, airway clearance, exercise, and good habits all matter, but none of it works if your body doesn’t have the nutrients it needs to heal. #HealthyEating #EatForHealing #ProteinPower #Bronchiectasis #NTMLungDisease #NutritionMatters #RespiratoryHealth  For me, educating people about bronchiectasis isn’t just about explaining the disease—it’s also about advocating for early diagnosis. The sooner people receive the right care, the better their outcomes.
That’s why I actively share insights on LinkedIn, where I’ve built a strong community of over 8,000 connections, including many respiratory therapists and clinicians. Engaging with this network is another way I advocate for early detection, ensuring that more people recognize the signs of bronchiectasis and get the care they need as early as possible. ⭐️⭐️This is my latest LinkedIn post:⭐️⭐️ There are people who have bronchiectasis (BE) and also have asthma and/or COPD. However, according to Dr. Charles Daley, one of the top BE and NTM doctors in the world, there are others who are incorrectly diagnosed with asthma or COPD when, in fact, they have bronchiectasis. As he recently said: (This transcription may contain minor errors.) “I would go out on a limb here and say, even though I can’t prove this point, I think most people with bronchiectasis have never been diagnosed, because to get diagnosed, the clinician, the provider, has to order a CT scan. And if you don’t do that, then they’re going to just say your chronic cough is asthma, or it’s COPD, or as allergies is something else, but until you get the chest CT, you can’t see the dilated airways. And once you do that, then you can call this bronchiectasis. There are many paths that lead to the condition bronchiectasis, but the symptoms are really what should drive the thinking about bronchiectasis. So a person has a chronic cough for months, often it’s producing sputum. They often have recurrent infections, and we call those exacerbations… So those are the things that should key the clinician to say, maybe this isn’t asthma. Maybe I should get an imaging study and figure out if this is bronchiectasis.” Respiratory therapists: If you’re working with patients who are coughing, have sputum and are not improving on their current treatment, they might have bronchiectasis. Please bring it to the attention of your team physician. New bronchiectasis treatments are in the pipeline with some becoming available this year. These treatments could greatly improve the quality of life for your patients. #RespiratoryCare #PulmonaryHealth #RespiratoryTherapist #Bronchiectasis #NTM #Asthma #COPD |
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
May 2025
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