Novel Treatment Options for Bronchiectasis

Clinical Brief: Emerging Therapies for Bronchiectasis

Main Discussion Topics

• DPP1 inhibitors target neutrophil inflammation in bronchiectasis.
• Eosinophilic bronchiectasis (approximately 30% of cases) benefits from targeted therapies.
• Approaches to treatment vary based on inflammatory phenotype.

Key Points for Physicians

• DPP1 inhibitors:
  • Target abnormal neutrophil function and reduce neutrophil serine proteases
  • May prevent formation of neutrophil extracellular traps
• Aim to reduce exacerbations and disease progression
• For eosinophilic bronchiectasis (30% of cases):
  • Inhaled corticosteroids are beneficial
  • Anti-IL5 therapies show promise
  • Biologic therapies are being investigated
• Discourage inhaled corticosteroids in neutrophilic bronchiectasis (70% of cases) due to potential infection risk.

Notable Insights

Peripheral eosinophil counts may help guide treatment decisions similar to their use in chronic obstructive pulmonary disease management, with different thresholds being investigated.

Clinical Significance

Emerging therapies targeting specific inflammatory pathways show promise for more precise treatment of bronchiectasis based on inflammatory phenotype.