The Future of Bronchiectasis: Prevention, Not Just Treatment

In "The Future of Bronchiectasis: Prevention, Not Just Treatment," Dr. Sala closes this series by looking ahead to the therapies and tools that could reshape bronchiectasis care.

Dr. Sala closes with genuine optimism about where bronchiectasis research is headed. He expects continued growth in anti-inflammatory strategies beyond DPP1 inhibitors, including exploring whether other biological pathways matter for specific patient subtypes within the broader bronchiectasis population. Some patients, he notes, present with a TH2, eosinophil-driven phenotype that might respond to the biologic therapies already used in asthma and COPD, though the field doesn't yet know whether that extrapolation holds true. Further out, Dr. Sala anticipates demand for better antibiotics with fewer side effects, particularly for difficult organisms like Mycobacterium abscessus, and highlights phage therapy, viruses engineered to target specific bacteria, as a promising, still-emerging approach to building more precise antibacterial cocktails for patients in the years ahead.

Dr. Sala's biggest long-term hope, though, is developing genuine preventative strategies for airways disease. He draws a direct comparison to cardiology, where a patient's LDL cholesterol feeds a validated calculator estimating future cardiovascular risk, and where therapy can then measurably lower that risk over time. Pulmonology has no equivalent tool today, he says, and developing one, a reliable biomarker paired with a risk calculator and an intervention that measurably shifts someone's trajectory, remains the field's holy grail. Dr. Sala believes bronchiectasis has plausible biomarker candidates worth pursuing toward that goal, even though achieving it is still a distant, long-term research objective for the field. He sees this predictive, preventative model as valuable not just for bronchiectasis, but potentially for other chronic pulmonary diseases as well going forward, once the underlying science catches up.

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