One Year of Brensocatib: How Bronchiectasis Care Has Changed

One year after the FDA approved brensocatib (Brinsupri) as the first disease-modifying therapy for non-cystic fibrosis bronchiectasis, pulmonologists who prescribe it daily describe a field transformed from having no targeted treatment at all to weighing a genuine, if imperfect, first-in-class option.

The August 12, 2025 approval was built on the phase 3 ASPEN trial, the largest study ever conducted in bronchiectasis, enrolling 1721 patients.¹ Brensocatib, an oral inhibitor of dipeptidyl peptidase-1 (DPP-1), works by dampening the neutrophil-driven inflammation that fuels the disease's cycle of infection and airway damage. In ASPEN, both the 10-mg and 25-mg doses reduced annualized exacerbation rates by 20% compared with placebo, and the 25-mg dose also slowed lung function decline by 38 mL over 12 months.²

"It's been nice to have an option that we didn't have before, even from the perspective of the patients who are always looking for another possibility, another potential treatment to improve their lives," said Mark L. Metersky, MD, professor of medicine, chief of the Division of Pulmonary, Critical Care, and Sleep Medicine, and director of the Center for Bronchiectasis Care at UConn Health. "Many patients were aware of this drug that was being investigated and that it looked promising."

What is the 1-year real world experience?

Metersky said most patients on brensocatib report feeling better, even when they cannot fully explain why. Some describe less coughing or easier sputum clearance; a smaller subset describe the effect as transformative, with cough nearly resolved and quality of life meaningfully improved.

"For most patients, I won't say it's life-changing, but they feel better, and that's important," he said. "We don't always expect a miracle, so we temper enthusiasm for anything because we generally don't get miracles, but this drug clearly has improved patients' lives."

Ashwin Basavaraj, MD, section chief of pulmonary, critical care, and sleep medicine, and director of the Bronchiectasis and NTM Program at NYC Health + Hospitals/Bellevue, described a similar sense of momentum.

"We have patients with bronchiectasis that have suffered for years, not knowing what to do and not knowing where to turn in terms of improvement in their symptoms, and now there's an available therapy where we have seen in some patients a dramatic improvement in some of the symptoms," said Basavaraj, who is also associate director of the bronchiectasis program at NYU Langone Health. "Each patient is going to respond differently. But in general, I think it's exciting that there's a new therapy that patients can benefit from, and really exciting that there's a lot of research ongoing right now for additional therapies that has the potential to improve patients with bronchiectasis."

How do new guidelines reflect the change?

The 1-year mark coincided with another milestone: in 2026, the American College of Chest Physicians (CHEST) published its first North American clinical practice guideline for adult bronchiectasis, comprising 13 conditional recommendations.³ Brensocatib is among them.

"Between our new CHEST guidelines and other guidelines that have been released, I think there's been a pretty good job of covering most of the issues related to diagnosis and treatment," Metersky said. "The new aspect covered by the CHEST guidelines is brensocatib, obviously, because it wasn't available when the other guidelines were being produced. But the CHEST guidelines do recommend brensocatib, so that's something novel." Metersky noted the guideline also newly addresses hemoptysis management, recommending tranexamic acid, a long-available drug with emerging evidence of benefit in chronic lung disease, for a complication he said "may not be on the radar screen for many pulmonologists."

Metersky was careful to note that guideline coverage does not equal resolved unmet need. "Despite all of the treatments available, patients still have a large unmet need with chronic cough and sputum, frequent exacerbations, progression of disease," he said, adding that further gaps will only be closed by continued drug development.

Who to select for brensocatib?

Bronchiectasis is a heterogeneous disease, and both physicians pointed to unresolved questions about who benefits most. One is particularly relevant in the US: nontuberculous mycobacteria (NTM), an underlying chronic infection Basavaraj said affects roughly half of US patients with bronchiectasis, per the US Bronchiectasis and NTM Research Registry, a substantially higher proportion than seen in Europe.

"That question does exist: what potential impact do some of these therapies have on some of these chronic infections, such as NTM?" Basavaraj said. "I think there's more data that needs to be evaluated in outcomes of patients with NTM and DPP-1 inhibitors, and it's data that we are currently collecting right now." He added that NTM is not a contraindication to brensocatib use and that his practice has not observed worsening of chronic infection with the therapy, but he emphasized that dedicated outcomes data in this overlapping population remain limited.

What barriers are there to brensocatib access?

Basavaraj oversees bronchiectasis care in 2 distinct New York City patient populations: an academic program at NYU Langone and a public-hospital program at NYC Health + Hospitals/Bellevue. The latter, he said, sees a different demographic profile than most bronchiectasis clinical trial cohorts, with a higher proportion of Asian and African American patients and fewer white patients than typically represented in trial populations.

"I think it's really important to study those patient populations and really try to include them into some of these clinical trials, so we can have a real-world representation in research for all patients with bronchiectasis," Basavaraj said. He reported that his public-hospital cohort has broad access to advanced bronchiectasis therapies, with no major barriers currently limiting uptake of new treatments including brensocatib. "We want to ensure that they get the same standard of care therapy that all patients with bronchiectasis deserve," he said.

What is brensocatib’s real world tolerability?

Brensocatib's adverse event profile includes findings less familiar to pulmonologists than typical respiratory drug effects: periodontal disease and localized skin thickening and sloughing. Metersky said neither has meaningfully affected patient acceptance of the drug in his practice.

"In general, that's not been an issue that patients fear," he said. "I had one patient who asked if all her teeth were going to fall out if she started it, and of course I reassured her that periodontal disease doesn't work that way. In truth, we didn't really see a significant signal for increased risk of periodontal disease in the phase 3 study."

He advises patients to maintain routine dental hygiene and follow-up, noting that any periodontal changes would likely develop slowly and be caught early. Skin changes, involving thickening and sloughing behind the knees, elbows, feet, or hands, have occurred in only 1 of his patients to date. "Other than that, it's not been an issue," Metersky said.

Brensocatib's development history outside bronchiectasis has been mixed. A phase 2b trial in hidradenitis suppurativa failed to meet its primary and secondary efficacy endpoints in 2026, leading the manufacturer to discontinue that development program, a reminder that the drug's demonstrated benefit to date is specific to non-cystic fibrosis bronchiectasis.⁴

One year in, both physicians describe a field that has gained a genuine first-in-class treatment and, now, a first national guideline to help direct its use, alongside real questions still being worked out about which patients benefit most, how the drug performs alongside common comorbid infections, and how its early real-world safety profile holds up over time.

Basavaraj and Metersky’s disclosures include Insmed and others.

References

1. FDA approves first bronchiectasis therapy, brensocatib, for ages 12 and up. HCPLive. https://www.hcplive.com/view/fda-approves-first-bronchiectasis-therapy-brensocatib-12-up. Published August 12, 2025. Accessed August 13, 2026.

2. Redefining bronchiectasis care with brensocatib FDA approval, with James Chalmers, MBChB, PhD. HCPLive. https://www.hcplive.com/view/redefining-bronchiectasis-care-brensocatib-fda-approval-chalmers. Published August 11, 2026. Accessed August 13, 2026.

3. CHEST guideline 2026: 13 recommendations for non-CF bronchiectasis. HCPLive. https://www.hcplive.com/view/chest-guideline-2026-13-recommendations-bronchiectasis. Accessed August 13, 2026.

4. Brensocatib phase 2b study in HS does not meet endpoints, program discontinued. HCPLive. https://www.hcplive.com/view/brensocatib-phase-2b-study-hs-does-not-meet-endpoints-program-discontinued. Published April 2026. Accessed August 13, 2026.