By: Michael S. Alvarez, DO, MPH, FCCP
Treatment Options
If you have been told you have bronchiectasis, you may be wondering what it really means, what caused it, and what you can do about it. This chronic lung condition is not as widely recognized as asthma or COPD, but it is just as important to diagnose and manage properly. Let’s take a closer look at what bronchiectasis is, how it develops, how doctors diagnose it, and the modern treatment strategies—including new medications like brensocatib (Brinsupri)—that are changing the outlook for patients.
What Is Bronchiectasis?
Bronchiectasis is a disease where the airways in the lungs become abnormally widened, scarred, and damaged. In a healthy lung, the airways act like flexible tubes that carry air in and out while moving mucus up and out efficiently. In bronchiectasis, however, the airway walls lose their normal structure. They become floppy and scarred, mucus clearance is impaired, and secretions collect instead of being swept away. This stagnant mucus creates the perfect environment for bacteria to grow. Over time, repeated cycles of infection and inflammation cause even more airway damage. The result is a vicious cycle: damaged airways, mucus buildup, infection, inflammation, and more airway injury.
What Causes Bronchiectasis?
There are many possible causes of bronchiectasis. Sometimes, the exact cause is never found. It may occur after a severe lung infection, or in people with chronic lung diseases such as COPD, cystic fibrosis, or severe asthma. Immune system problems that make it harder to fight infections can play a role, as can recurrent aspiration or reflux, where food or stomach acid repeatedly enters the lungs. In other cases, rare genetic or structural problems with the airways are to blame.
Certain conditions are often seen alongside bronchiectasis and can make it worse. Two of the most important are nontuberculous mycobacteria (NTM), which are slow-growing bacteria that can cause chronic lung infection, and allergic bronchopulmonary aspergillosis (ABPA), an allergic reaction to a common fungus that drives inflammation and mucus plugging.
Recognizing the Symptoms
The symptoms of bronchiectasis can look very similar to other lung diseases, which is why it is often underdiagnosed. A chronic cough is almost always present, and patients often bring up mucus on a daily basis. Recurrent chest infections that require antibiotics are another hallmark, along with shortness of breath, wheezing, fatigue, and reduced exercise tolerance.
The best way to confirm bronchiectasis is with a CT scan of the chest, which clearly shows the widened and irregular airways. Other parts of the evaluation may include sputum cultures to check for bacteria or fungi, blood tests to evaluate the immune system, and pulmonary function tests to see how well the lungs are working.
Treatment Strategies
There is no cure that can reverse the airway damage once it has developed, but treatment can dramatically improve quality of life, reduce infections, and slow disease progression.
The cornerstone of management is daily airway clearance. Chest physiotherapy, special breathing exercises, and mechanical techniques such as oscillatory flutter devices or vest therapy help mobilize mucus. Inhaled saline solutions, especially hypertonic saline, can thin mucus and make it easier to clear.
Antibiotics are used both for acute flare-ups and, in select cases, for long-term suppression. Some patients inhale antibiotics such as tobramycin to reduce bacterial load in the lungs. Certain oral antibiotics, like azithromycin, may also reduce flare-ups because of their anti-inflammatory effects.
One of the most promising developments in the field is the drug brensocatib (Brinsupri). This new oral therapy is designed to block an enzyme called neutrophil elastase, which drives much of the destructive inflammation in bronchiectasis. Clinical trials have shown that it may significantly reduce the number of exacerbations and help preserve lung function. This is now FDA approved and is an exciting step forward that offers hope for patients with frequent flare-ups despite standard therapy.
It is also essential to treat any coexisting conditions that worsen bronchiectasis. Patients with NTM infections often require long-term, multi-drug antibiotic regimens tailored to the specific type of bacteria. Those with ABPA may need steroids to reduce inflammation, along with antifungal medications.
Living with Bronchiectasis
Good overall lung health is another critical part of management. Vaccines such as influenza, pneumococcal, and COVID-19 are highly recommended. Smoking cessation is crucial, and pulmonary rehabilitation programs can help improve stamina and breathing efficiency.
Although bronchiectasis is a chronic condition, many people live active and fulfilling lives when they follow a structured care plan. Daily airway clearance, prompt recognition of infections, and regular follow-up with a pulmonary team are all important. With new therapies like brensocatib, treatment is expanding beyond symptom control and beginning to address the underlying drivers of inflammation.
Key Takeaway
Bronchiectasis is a condition where damaged airways trap mucus and lead to repeated infections, but it is manageable. With daily airway clearance, antibiotics, and new targeted therapies, many patients can breathe easier and live fuller lives.
At Tampa Pulmonary and Sleep Specialists, we take this a step further through our Premium Service, which provides personalized care, priority access, and a more comfortable experience. With a dedicated premium lounge to direct communication with our physicians, our concierge-style program is designed to give you the support you need to stay on top of your lung health.
If you have a chronic cough, frequent chest infections, or unexplained fatigue, make an appointment today to discuss whether evaluation for bronchiectasis—and the added benefits of our Premium Service—are the right next step for you.