Mark Metersky, MD, FCCP

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, cost, 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.