Brensocatib ‘a game changer’ in treatment of bronchiectasis  

The Irish Thoracic Society Annual Scientific Meeting took place from 20–22 November 2025 at the Galway Bay Hotel. Throughout the meeting, attendees heard from international and national experts in respiratory medicine about the latest developments and advances in the field.

The first guest lecture was delivered by Prof James Chalmers from the University of Dundee, Scotland, and Chief Editor of the European Respiratory Journal.

Prof Chalmers, a renowned consultant respiratory physician, runs a specialist clinic for patients with complex respiratory infections, particularly bronchiectasis, at Ninewells Hospital, Dundee.

In his talk, ‘Big news for bronchiectasis’, he highlighted bronchiectasis research as a rapidly advancing and dynamic field, encouraging early-career attendees to consider it as a focus within the specialty.

The meeting heard that patients with bronchiectasis face a significant symptom burden and frequent exacerbations, with around 25 per cent requiring hospitalisation for an exacerbation each year across Europe.

“This is not a mild disease,” Prof Chalmers said, adding the condition was “incredibly heterogeneous”.

He said that the condition is his passion, having worked in the area for the last 20 years, and, for him, a “major driver” of clinical trials has been to discover improved treatment options.     “There is a lot happening in bronchiectasis. But this was a field where historically there hasn’t been a lot going on,” he said.

“In the last one to two years, it really has been transformed.”

Previously, Prof Chalmers noted that bronchiectasis had long been neglected and viewed as a condition of limited significance.

“It was [believed to be] rare. It was predominantly caused by tuberculosis (TB), and in places like Western Europe, where TB rates were going down, bronchiectasis [was thought to] disappear,” he said. “[But] we now know that bronchiectasis rates have been rocketing in the last twenty to thirty years, as we recognised these cases with the advances in CT.”

This recent surge in activity has led to a dramatic rise in bronchiectasis clinical trials, increasing from a single study in the early 2000s to more than 10 randomised controlled trials completed or reported last year.

Regarding treatments, he noted that long-term macrolides are highly effective, yet only 17 per cent of patients across Europe currently receive them.

“We know they reduce exacerbations, but for some reason they don’t get used as a preventative therapy for most of those frequent exacerbators,” he said.

He added that significant work was required to provide a common, high standard of care for people with bronchiectasis, and “a lot of that starts with trials”.

Prof Chalmers said that earlier this year, the US Food and Drug Administration approved 10mg and 25mg doses of brensocatib, while the European Medicines Agency (EMA) approved the 25mg dose in November, marking the first ever licensed therapy for bronchiectasis. He added that clinical trial data showed brensocatib reduced exacerbations by 20 per cent at both doses.

He noted that the 25mg dose offers the same efficacy in reducing exacerbations, while also providing additional benefits for lung function and symptoms. “I think the EMA has made the right decision,” he said. “And there is much more to come – there are trials opening up everywhere because of the success of brensocatib and the availability of data.”

Prof Chalmers concluded that the new guidelines encourage clinicians to take a proactive approach in managing bronchiectasis patients.

He reiterated that macrolides are often the first-line treatment and, while not suitable for everyone, they are very effective, adding that “brensocatib is going to be a game changer”.

Prof Chalmers urged the meeting to also address other treatable aspects of bronchiectasis, including exercise, bronchodilators, and additional supportive therapies.

“There is a lot we can do for these patients, and we should be aiming to improve everyone’s outcomes.”