Recent developments in bronchiectasis discussed at the ATS 2024 International Conference reflect the growing interest and continued progression in advancing the research and patient care for people with the disease.

Multiple sessions, including “NTM with a Side of Bronchiectasis” and “Bronchiectasis and NTM Pulmonary Disease: Risk Factors, Management, and Recent Advances,” focused on distinguishing, diagnosing, and managing nontuberculous mycobacteria (NTM) and bronchiectasis. These aspects remain challenging for providers due to scarce evidence-based clinical management strategies.

“Bronchiectasis and NTM are difficult to treat due to the lack of a solid evidence base and the fact that disease presentation and progression can be quite heterogeneous,” explained George M. Solomon, MD, associate professor of medicine at the University of Alabama at Birmingham. “Recent trials showing positive findings on frequently exacerbating bronchiectasis patients using brensocatib are particularly exciting.”

The poster discussion session, “Unlocking NTM/Bronchiectasis Mysteries,” highlighted emerging therapeutic options being analyzed for NTM infections. The abstracts for these presentations can be found on the ATS Journals website.

“The bronchiectasis arena is also investigating novel endotypes which may have treatment implications,” Dr. Solomon said.

During “Bring Your Best Biomarker: Molecular Success Stories in Chronic Lung Disease,” presenters focused on the arduous process of translating biomarker development into findings that impact clinical practice. The session highlighted biomarker successes across COPD, ILD, and bronchiectasis, in part to promote and identify opportunities for interdisciplinary and cross-subspecialty collaboration.

The airway microbiome has been increasingly recognized as an important component in the pathology and efficacy of treatment for diseases like bronchiectasis and COPD. Further studies could lead to significant new insights about the underlying mechanisms of the disease.

“Disruption of the diversity of the microbiome is an emerging biomarker of exacerbations and possibly related to treatments such as inhaled corticosteroids and antibiotics,” Dr. Solomon said. “The disruption of the microbiome is particularly intriguing as a biomarker in bronchiectasis due to the central role of chronic infection in disease progression.”

While bronchiectasis remains a complex, heterogeneous disease that demands further research and clinical advancement, hope and optimism remain while looking toward the future of the field. Dr. Solomon highlighted multiple recent developments related to bronchiectasis that exemplify these reasons for enthusiasm and persistence.

“First, novel endotypes including eosinophilic and neutrophilic bronchiectasis are pointing us toward therapeutic options,” he said. “Secondly, new understandings of mucus clearance defects are informing us in the development of novel mucoactive therapies. Finally, new understandings of antibiotics may provide access to efficacious antibiotics for chronic infections.”