Joseph Khabbaza, MD

A more precise, endotype-driven understanding of bronchiectasis, paired with an expanding treatment pipeline, is reshaping expectations for what long-term disease control can look like.

Turning new bronchiectasis guidelines into everyday practice demands more than awareness, requiring hands-on familiarity with unfamiliar therapies and dedicated staff to share the treatment burden.

Additional DPP1 inhibitors in development show early promise, even as persistent gaps in physician education and validated biomarkers continue to limit optimal bronchiectasis care.

With multiple therapeutic classes now available, sequencing macrolides, DPP1 inhibitors, and emerging antibody therapies requires weighing safety and each patient's underlying disease drivers.

Landmark phase 3 data on DPP1 inhibition mark a shift toward targeting the neutrophilic inflammation that drives bronchiectasis progression, rather than only its downstream consequences.

Pseudomonas colonization narrows the antibiotic options available for bronchiectasis exacerbations, making inhaled antibiotic strategy a pivotal decision point in long-term management.

Airway clearance delivers meaningful benefit only when patients actually use it consistently, making education and treatment-burden awareness as important as the devices themselves.

Balancing chronic suppressive therapy against acute exacerbation management remains a case-by-case calculation, particularly as antibiotic duration guidance continues to lack strong supporting evidence.

The first North American bronchiectasis guidelines introduce new recommendations on anti-inflammatory therapy and hemoptysis management that could reshape standard practice going forward.

Left undertreated, bronchiectasis exacts a cumulative toll on lung function and daily life, underscoring why early, sustained airway clearance remains central to preserving both.

Comprehensive bronchiectasis care depends on a coordinated team extending well beyond the pulmonologist, from respiratory therapists to pharmacists to surgical specialists.

Knowing which patients belong in general pulmonology versus a specialty center hinges on exacerbation frequency, organism resistance, and the intensity of airway clearance support required.

Precise CT criteria and a low threshold for imaging in uncontrolled asthma or COPD can shorten the path to a bronchiectasis diagnosis that too often arrives years late.

A self-reinforcing cycle of impaired clearance, inflammation, and infection drives bronchiectasis progression, and neutrophilic inflammation emerges as the strongest predictor of long-term outcomes.

Behind every bronchiectasis diagnosis lies a distinct cause, from post-infectious injury to immune deficiency, and identifying it can meaningfully change how a patient is treated.

Chronic productive cough and recurring antibiotic courses are frequently dismissed as ordinary bronchitis, delaying recognition of bronchiectasis that a handful of clinical clues could reveal much earlier.

Rising incidental detection on CT imaging is transforming bronchiectasis from a rare diagnosis into a far more common condition clinicians must actively watch for across everyday practice.

Panelists discuss the ongoing challenge of engaging patients, providers, and families in understanding the long-term risks of frequent oral corticosteroid use in chronic obstructive pulmonary disease (COPD), emphasizing the importance of clear communication about serious adverse effects—including mental health and cardiovascular risks—and the role of electronic medical records in early intervention; they note that patients often feel well between exacerbations and may undervalue steroid-sparing strategies, so personalized education focusing on preventing future harm is key, and express optimism that new biologics offer promising options to reduce exacerbations and steroid dependence, highlighting the evolving, hopeful landscape of COPD care.

Panelists discuss the introduction of 2 biologics for patients with chronic obstructive pulmonary disease (COPD) with high blood eosinophils and frequent exacerbations as a major advancement, highlighting their ability to reduce exacerbations and steroid use; they note differences in dosing schedules, inflammatory markers, and patient preferences that influence therapy choice, emphasize the role of shared decision-making amid cost and insurance challenges, and acknowledge that trial and error may be needed to personalize treatment while calling for more research to optimize biologic use.

Panelists discuss the importance of early identification of patients with chronic obstructive pulmonary disease (COPD) at risk for exacerbations through targeted clinical questioning about recent hospitalizations, emergency visits, and steroid or antibiotic use, noting that many patients underreport or misunderstand exacerbations; they emphasize patient education, improved communication across multiple providers, and the integration of electronic medical records and patient portals as key strategies to enhance monitoring, ensure timely treatment escalation, and ultimately reduce exacerbation frequency and severity.

Panelists discuss common barriers to timely escalation of chronic obstructive pulmonary disease (COPD) treatment, including infrequent follow-up visits, fragmented care across multiple providers, and delayed communication of exacerbations or hospitalizations, as well as therapeutic inertia stemming from competing clinical priorities and insufficient patient education; they emphasize the need for integrated, proactive strategies such as shared electronic medical records, rapid posthospitalization follow-up, care coordination, and enhanced patient engagement to overcome these challenges and optimize treatment adjustments.

In this video, the last in a 6-part series, panelists discuss the potential future impact of biologics in the COPD field.

In this video, the fifth in a 6-part series, panelists discuss the factors that influence initiating biologics for COPD.

In this video, the fourth in a 6-part series, panelists discuss how future studies of monoclonal antibodies in COPD could be refined.

In this video, the third in a 6-part series, panelists discuss how learnings from asthma management are informing COPD management.

In this video, the second in a 6-part series, panelists discuss using monoclonal antibodies in early-line COPD treatment.

In this video, the first in a 6-part series, panelists discuss the impact of monoclonal antibodies for COPD management.

Panelists discuss the critical factors guiding therapy escalation in chronic obstructive pulmonary disease (COPD), emphasizing thorough evaluation of symptoms, exacerbation history, and medication adherence; they highlight the foundational role of standard inhaled therapies and nonpharmacologic interventions like pulmonary rehabilitation and smoking cessation, while noting that newer treatments, including biologics, are reserved for patients with persistent exacerbations despite optimized care, with decisions shaped by shared decision-making and personalized considerations such as inhaler technique and delivery method to improve outcomes and quality of life.

Panelists discuss the nuanced relationship between chronic obstructive pulmonary disease (COPD) and asthma through the lens of type 2 inflammation, emphasizing that while both diseases share inflammatory pathways and a treatable trait, they remain distinct conditions with differing manifestations and treatment responses; they highlight that asthma-COPD overlap affects 15% to 20% of patients, but type 2 inflammation is a separate COPD subtype rather than evidence of dual diagnosis, underscoring the importance of precise phenotyping to guide personalized treatment strategies that balance efficacy, safety, and patient-specific factors.

Panelists discuss the prevalence and complexity of type 2 inflammation in chronic obstructive pulmonary disease (COPD), noting that blood eosinophil counts—using thresholds of 150 to 300 cells/µL—identify roughly 30% to 50% of patients with this phenotype, while emphasizing that not all elevated eosinophil cases reflect true type 2 inflammation; they highlight additional markers like allergen sensitization and immunoglobulin E (IgE), the association of type 2 inflammation with increased symptoms and exacerbations, and the ongoing need for refined phenotyping and targeted therapies to address the heterogeneity of COPD inflammation.