For non-cystic-fibrosis bronchiectasis, 2025 brought a genuine milestone: the first-ever approved disease-modifying therapy. Brensocatib (Brinsupri), an oral inhibitor of dipeptidyl peptidase-1 (DPP-1), blocks the activation of neutrophil serine proteases that drive the neutrophilic airway inflammation central to the disease. In the Phase 3 ASPEN trial — the largest ever in bronchiectasis — brensocatib reduced pulmonary exacerbations by about 20%, slowed the decline in FEV1, and improved quality of life, leading to FDA approval in August 2025 for adults and adolescents aged 12 and older. This addresses a root inflammatory mechanism rather than just managing infection, and is widely regarded as a paradigm shift.
Alongside this, established approaches remain important: inhaled antibiotics reduce exacerbations in patients with chronic infection (such as Pseudomonas), long-term macrolide therapy (azithromycin) reduces exacerbation frequency and improves quality of life (with antibiotic resistance a genuine concern), and airway clearance remains foundational.
Further reading: ASPEN Phase 3 brensocatib (Chalmers et al., NEJM 2025) and FDA approval (2025); inhaled antibiotics meta-analysis (Cordeiro et al., Chest 2024); long-term macrolides IPD meta-analysis (Chalmers et al., Lancet Respiratory Medicine 2019).