Colin Swenson, MD

Years of misdiagnosis as asthma or COPD can leave bronchiectasis patients with irreversible lung damage, underscoring the clinical clues physicians need to catch the disease sooner.

Bronchiectasis may have countless underlying causes, but its structural and inflammatory endpoint looks strikingly consistent, a distinction reshaping how the field approaches diagnosis and treatment.

Behind every case of bronchiectasis is a self-perpetuating cycle of cough, breathlessness, and infection that leaves many patients unable to return to their prior baseline health.

Bronchiectasis pathophysiology looks less linear and more dynamic than once believed, and its true prevalence appears far higher than commonly assumed across the adult population.

From eosinophil-targeted biologics to a cardiology-style risk calculator, Dr. Sala outlines the innovations that could finally make bronchiectasis prevention, not just treatment, possible.

Bronchiectasis isn't reversible, so Dr. Sala focuses on coaching patients toward a sustainable relationship with chronic cough rather than chasing a cure that doesn't exist.

Payer access to a new bronchiectasis therapy has mostly gone smoothly, but Dr. Sala describes pushing back against outdated prior-therapy requirements that trials never required.

With more therapies now available, Dr. Sala walks through how he layers DPP1 inhibition alongside existing treatments, and the one group that needs it most urgently.

A first-in-class neutrophil-targeted therapy has given clinicians a new tool against bronchiectasis, but Dr. Sala says key populations, including the immunocompromised, still lack answers.

Panelists discuss how bronchiectasis is more common than previously thought, with growing awareness, research, and specialized centers improving diagnosis and treatment options, though challenges remain in standardizing care and securing insurance coverage for therapies.

Panelists discuss how future bronchiectasis research will focus on precision medicine, identify treatable traits, and expand networks of Centers of Excellence to provide advanced care and clinical trial access for patients.

Panelists discuss how emerging DPP1 inhibitor therapies target neutrophil serine proteases to reduce neutrophilic inflammation and neutrophil extracellular trap formation in bronchiectasis.

Panelists discuss how surgical approaches for bronchiectasis have evolved from open thoracotomy to minimally invasive techniques (VATS or robotic assisted), reducing hospital stays from 5 to 7 days to 1 to 3 days and recovery time from 6 to 8 weeks to 2 to 6 weeks.

Panelists discuss how the heterogeneity of bronchiectasis requires precise phenotyping and a treatable traits approach to address varying symptom profiles, from cough-predominant to shortness of breath–predominant presentations.

Panelists discuss how preventing bronchiectasis exacerbations involves understanding a patient’s past exacerbation pattern, implementing comprehensive airway clearance, patient education, and early intervention.

Panelists discuss how ideal candidates for bronchiectasis surgery have localized disease on CT scan and bronchoscopy, adequate pulmonary function (orced expiratory volume in 1 second > 40%), and whose infections are controlled prior to surgery.

Panelists discuss how reducing bronchiectasis exacerbations requires standardized definitions, tailored antibiotic approaches, and increased airway clearance, while addressing underlying conditions and ongoing research into optimal treatment protocols.

Panelists discuss how airway clearance devices and techniques, including chest physical therapy, active cycle breathing, exercise, hypertonic saline, and oscillatory positive expiratory pressure devices, are the mainstay of bronchiectasis management.

Panelists discuss how evaluating potential causes of bronchiectasis is important despite many cases being idiopathic, as identifying treatable traits can lead to specific interventions, such as CFTR modulators for those with CF mutations or IgG supplementation.

Panelists discuss how managing bronchiectasis exacerbations involves targeted antibiotics based on sputum cultures, augmenting mucus clearance with devices, and considering surgical intervention when medical management fails.

Panelists discuss how bacterial infections, environmental triggers, and microbiome imbalances cause bronchiectasis exacerbations, leading to increased cough, phlegm, fatigue, and hemoptysis.

Panelists discusses how the "vicious vortex model" explains bronchiectasis pathophysiology, where airway dilatation leads to mucus stagnation, chronic infections, and neutrophilic inflammation, worsening the condition.

Panelists discusses how bronchiectasis differs from other respiratory diseases like asthma and COPD through symptoms, imaging findings, and pathophysiological mechanisms.