Bronchiectasis management is shifting from a model built almost entirely around responding to exacerbations and clearing mucus toward one that also targets the underlying neutrophilic inflammation driving those flares. Mark Sala, MD, of Northwestern Medicine, explains how permanently dilated airways set off a cycle of mucus retention, infection, and inflammation; why existing airway clearance, mucolytic, and antibiotic strategies leave a significant gap in exacerbation prevention; and how the new DPP-1 inhibitor class — including brensocatib, which reduced annualized exacerbations by about 20% in the ASPEN trial — offers the first new oral anti-inflammatory mechanism for the disease in years. The conversation closes with what payers and managed care leaders should be asking about cost, appropriate use, and coverage policy as this treatment category expands.
