Panelists Push for Standardization in Bronchiectasis Care

Panelists at a Population Health Roundtable hosted by The American Journal of Managed Care^® shed light on the current state of bronchiectasis care in the clinical and health care landscape and its impact on patients' quality of life. The conversation, moderated by Marc A. Sala, MD, an associate professor of medicine (pulmonary and critical care) at Northwestern University's Feinberg School of Medicine, saw a diverse group of pulmonary and bronchiectasis specialists who convened in Chicago on August 6, 2026.

The Current State of Bronchiectasis Clinical Care and Representation

The prevalence of bronchiectasis in the US has risen approximately 8% per year since 2001.¹ A pooled global estimate, drawn from 15 studies encompassing more than 437 million individuals, puts this prevalence at 680 per 100,000 adults, whereas a separate US-specific estimate places it at 478 per 100,000 adults.^1,2 Several risk factors continue to drive exacerbations and disease progression, including asthma, airway inflammation, and environmental exposures—along with prior exacerbations, the strongest predictor of future events.³

Many conditions overlap with bronchiectasis, sometimes complicating or delaying diagnosis, which currently takes 3 years or more from symptom onset, according to recent data.^1,2 Gaps in care also vary by institution, which is why Sala opened the conversation by asking panelists to describe the standard-of-care structures for bronchiectasis at their institutions. Some institutions are further along in developing dedicated bronchiectasis care strategies, he noted, whereas others remain in earlier stages of innovation, such as UI Health at the University of Illinois Chicago.

Malvika Kaul, MD, an assistant professor of clinical medicine and pulmonary and critical care physician at UI Health, said, “Within my institution, we are trying to become one of the centers within the bronchiectasis NTM [nontuberculous mycobacteria] network, which entails having a dedicated space and time for seeing the bronchiectasis patients.”

Rush University Medical Center/Rush Medical College is also in the early stages of developing structures around bronchiectasis care, and its clinicians are still building referral pathways to a dedicated bronchiectasis clinic, said Elaine Chen, MD, an associate professor of internal medicine and a pulmonary, critical care, hospice, and palliative medicine physician at Rush.

“We recently, within the past 6 months or so, got specific bronchiectasis blocks in our clinic, which is a big improvement,” she said. “And I’ve been getting a lot more bronchiectasis patients in the past few months.”

By comparison, institutions such as Feinberg have established bronchiectasis NTM programs, according to Thaddeus R. Cybulski, MD, PhD, pulmonologist and assistant professor of medicine at Feinberg.

“There are several physicians, both on the pulmonary side as well as collaborators in infectious disease as well as allergy immunology,” he said.

Expanding Multidisciplinary Care

The panelists also emphasized the importance of multidisciplinary care and how cross-specialty consultation for bronchiectasis, in particular, meaningfully improves patient access.

“Because there are so many therapeutics now for all of the different things, inhaled antibiotics and all of that stuff, access to a specialty pharmacy is really helpful for these challenging patients,” Kaul said. “And having a pharmacist to guide you through all of that also is really helpful.”

Respiratory therapists are another essential building block of a comprehensive care team for patients with bronchiectasis, said Robert A. Balk, MD, professor emeritus in the Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine at Rush.

“We have respiratory therapy in our office area. It is also where the pulmonary function testing is done,” Balk said. “And the therapist, between tests or during the tests…can instruct [patients] in airway clearance or how to use certain devices and make sure that they are actually doing what they are supposed to be doing with the medications.”

Other panelists echoed Balk’s sentiments, attesting to the value respiratory therapy adds to treatment strategy and patient management in bronchiectasis care.

“I just send a message to my respiratory therapist, and 5 minutes later, they walk in with a PEP [positive expiratory pressure] device. I walk out, they do their first training, and then they head on out,” said Melissa Huml, DNP, APRN, CNP, a certified nurse practitioner specializing in pulmonology at Northwestern Medicine. “Our respiratory therapy department has been so helpful for us.”

Differences Across Academic and Community Care Settings

The panelists also surfaced significant differences in care models, resources, and structures for bronchiectasis across academic centers, community practices, and health systems. Sala pressed them to identify the biggest differences and how they translate into meaningful gaps in practice.

“Oftentimes, people in the community undermanage bronchiectasis because people focus more on inhalers and whatnot,” said Obada Shamaa, MD, PhD, a clinical instructor of medicine and a pulmonary and critical care physician at UChicago Medicine. “And it is interesting how life-changing just teaching people basic airway clearance [can be]. So, I think that is the big disconnect oftentimes.”

Balk added that academic centers, by contrast, have largely recognized the diagnostic gap and put plans in place to address it, whereas community and private practices more often lack the imaging and clinical history-taking needed to catch bronchiectasis in patients whose chronic cough, reflux, or sinus disease may be masking it.

“You have academic centers here that all have recognized the problem and have a plan in place to try to optimize management in various states of implementation,” Balk said. He added that without a CT scan or a thorough history in the community setting, “you are not making any of the diagnoses, and that is where the opportunity really sits.”

Differences between the 2 settings also show up in clinicians’ experience, particularly among those newer to bronchiectasis care, added David C. Nguyen, MD, an infectious diseases physician and an assistant professor at Rush.

“From an infectious disease standpoint, some of our private practice community infectious disease [physicians] may not have had as much experience with NTMs in particular, and so it can be challenging,” Nguyen said. “Not to mention just the coordination of obtaining the medications may be more difficult to obtain.”

Physical and Psychological Burden of Bronchiectasis Care

Panelists also pointed to gaps in how airway clearance is reinforced once it leaves the specialist’s office. Kaul noted that even when general pulmonologists prescribe it, high patient volumes often mean airway clearance becomes little more than a recommendation, without the follow-through to confirm patients understand it or are doing it—a gap she said specialized clinics are better resourced to close.

Shifting the conversation, Sala asked the panelists what they saw as the greatest burdens for patients diagnosed with bronchiectasis. “Which aspects of bronchiectasis care create the greatest burden for patients in terms of symptoms, daily functioning, quality of life, and health care utilization?” he asked.

Kaul pointed to the therapeutic burden patients face in simply keeping up with treatment.

“A lot of patients we see, and I’m sure we’re kind of in the same area, have poor health care literacy and a lot of other things going on, [and] they have a lot of other comorbidities,” she said. “So it’s hard for them, socioeconomically.”

Sala built on that point, asking panelists whether they had seen patients experience psychological burdens tied to their care or treatment. He said he tells patients, “I don’t know that you’re ever not going to be coughing. This is just who you are, and you have to come to terms with the fact that no matter what we do, you’ll be coughing throughout the day.”

Balk echoed that sentiment, adding that chronic disease is inherently burdensome, especially when adherence lapses: if patients miss a treatment day, their “symptoms only get worse,” he said.

“I had a patient today in clinic that I spoke to for a while, and she asked me, ‘When will the cough go away?’ And it was a hard conversation to say that it really won’t go away ever,” said Corrine Timmermann, RN, nurse and bronchiectasis program coordinator at Northwestern Medicine.

Closing the Gaps: What Comes Next for Bronchiectasis Care

The conversation was brought to a close by the panelists naming the gaps they most wanted to close, from inconsistent diagnostic workups to unmet airway clearance education and better management of frequent exacerbators. They repeatedly called for more standardization.

“I think for us, even among our own providers, despite being several doors down administratively, I think we lack standardization of how we’re doing things with our patients,” Sala said, adding that aligning treatment protocols, medication choices, patient education, and after-visit summaries across a single institution’s own providers was a near-term priority.

Chen said her team was pursuing 2 concrete steps: building a shared patient registry and applying for the Bronchiectasis and NTM Care Center Network (CCN) designation.

“We’ve got a shared Epic list of all our patients with CF [cystic fibrosis]. We should do that for our patients with bronchiectasis,” she said. “Bronchiectasis has been very scattered, so it needs to be a little bit more centralized.”

Shamaa said he planned to have medical assistants begin administering the COPD Assessment Test to patients—something that currently is left undone due to time constraints—and said he will keep pushing for a centrally located clinic model with infectious disease, despite institutional resistance tied to facility fees.

Balk agreed that standardizing workups and management, in addition to working toward CCN designation, would meaningfully move the field forward. Nguyen said he hoped institutions at the table would open more direct lines of communication between their pulmonology and infectious disease teams to share resources on medications such as clofazimine and omadacycline.

Several panelists pointed to the roundtable itself as a model worth repeating. What stood out most was “the value of this multidisciplinary powwow where we can all share our points of view,” said Elizabeth Kudlaty, MD, an allergist immunologist at UI Health. 

Timmermann agreed, adding that a longer-term goal would be to reconvene the group to work through shared case studies.

References

1. Wang L, Wang J, Zhao G, Li J. Prevalence of bronchiectasis in adults: a meta-analysis. BMC Public Health. 2024;24(1):2675. doi:10.1186/s12889-024-19956-y

2. Tkacz J, Lewing B, Feliciano J, et al. Real-world treatment patterns, health care resource utilization, and costs in a US Medicare population with bronchiectasis. J Manag Care Spec Pharm. 2024;30(9):967-977. doi:10.18553/jmcp.2024.30.9.967

3. Choi H, Chalmers JD. Bronchiectasis exacerbation: a narrative review of causes, risk factors, management and prevention. Ann Transl Med. 2023;11(1):25. doi:10.21037/atm-22-3437