Respiratory Trials·org

Topic

Bronchiectasis

Airway clearance, long-term macrolides, inhaled antibiotics, and DPP-1 inhibition.

Long-term macrolides reduce exacerbations substantially, cutting the proportion of patients having any exacerbation from 80% to 46% (BAT). As in asthma and COPD, exclude non-tuberculous mycobacterial infection first, and accept the unresolved resistance cost.

Brensocatib is the first drug developed for bronchiectasis itself, reducing exacerbations by about 20% and, at the higher dose, slowing FEV1 decline (ASPEN). Targeting neutrophil serine proteases rather than the organism is a genuinely new approach in a disease previously managed entirely with borrowed treatments.

Inhaled antibiotics for Pseudomonas have a split verdict: colistimethate reduced exacerbations by 39% in one trial and not in its replicate, which was terminated early and disrupted by the pandemic (PROMIS).

Mucoactive treatment is weaker than its popularity suggests. Neither hypertonic saline nor carbocisteine reduced exacerbations over a year (CLEAR). And extrapolating from cystic fibrosis is actively dangerous: DNase, a mainstay in CF, caused more exacerbations and faster lung function decline in idiopathic bronchiectasis (rhDNase in bronchiectasis).

Mucoactive treatment

Trial Year Therapy Effect Finding
CLEAR 2025 Hypertonic saline and carbocisteine Neither hypertonic saline nor carbocisteine reduced exacerbations in bronchiectasis
rhDNase in bronchiectasis 1998 Recombinant human DNase DNase made idiopathic bronchiectasis worse, not better

Inhaled antibiotics for Pseudomonas

Trial Year Therapy Effect Finding
PROMIS 2024 Colistimethate sodium Inhaled colistimethate reduced exacerbations in one trial and not in its replicate

Long-term macrolides

Trial Year Therapy Effect Finding
BAT 2013 Azithromycin Maintenance azithromycin roughly halved the proportion of patients having any exacerbation

Neutrophil serine protease inhibition

Trial Year Therapy Effect Finding
ASPEN 2025 Brensocatib Brensocatib cut exacerbations by about 20% — the first drug licensed specifically for bronchiectasis

Key references

Guidelines, standards and reviews for this topic.