Bronchiectasis Treatment: New Drug Brensocatib Targets Inflammation

For those living with non-cystic fibrosis bronchiectasis (NCFB), a chronic and progressive lung disease, the daily reality often involves managing a cycle of thick mucus, persistent coughing, and the constant worry of exacerbations. Until recently, treatment largely focused on alleviating symptoms – clearing airways and combating infections as they arose. But a significant shift began in 2025 with the U.S. Food and Drug Administration (FDA) approval of brensocatib (Brinsupri), the first medication designed to target the underlying inflammation driving NCFB, rather than simply addressing its effects. Understanding how this new treatment works, and what it means for those affected, is a crucial step toward more effective management of this challenging condition.

Understanding the Inflammatory Process in Bronchiectasis

Brensocatib’s approach is rooted in a deeper understanding of what happens within the lungs of people with bronchiectasis. When bacteria enter the lungs, the body naturally responds by sending neutrophils, a type of infection-fighting white blood cell, to the site. These cells are essential for eliminating germs and protecting the body. Yet, in individuals with bronchiectasis, this immune response can become overactive. Neutrophils release enzymes, called neutrophil serine proteases, to destroy bacteria. Over time, these enzymes can inadvertently damage healthy lung tissue, contributing to the progression of the disease.

As Dr. Amit “Bobby” Mahajan, system chief of interventional pulmonology at Inova Health System, explains, brensocatib works by intervening in this process. The medication blocks DPP1, an enzyme that activates those damaging enzymes within the neutrophils as they develop in the bone marrow. By reducing this activation, brensocatib limits the extent of lung injury caused by neutrophils. This can translate to reduced inflammation, less airway damage, and improved mucus clearance. “people are more functional, are feeling better, and are more active,” Dr. Mahajan says.

Clinical Evidence Supporting Brensocatib’s Apply

The FDA’s approval of brensocatib was based on data from two clinical trials. The phase 2 WILLOW study demonstrated that patients taking either 10 or 25 milligrams (mg) of brensocatib over 24 weeks experienced a 38 to 42 percent reduction in the risk of flare-ups. The study also showed that the medication extended the time between flare-ups and reduced neutrophil activity. Insmed, the pharmaceutical company that developed brensocatib, reported these findings in August 2025.

The larger phase 3 ASPEN trial further reinforced these results, showing a 20 percent reduction in annual flare-ups over 52 weeks for patients taking 10 and 25 mg doses. Both doses also increased the time to the first flare-up and the likelihood of remaining flare-up-free. Importantly, patients on the 25 mg dose exhibited less decline in lung function, as measured by forced expiratory volume – the amount of air a person can forcefully exhale in one second. Nature reported on the FDA approval and the underlying science of brensocatib in August 2025.

How Brensocatib Fits into Existing Bronchiectasis Treatment

It’s important to emphasize that brensocatib is not intended to replace existing bronchiectasis treatments. Rather, it’s designed to be used in addition to established therapies, such as postural drainage, chest percussion therapy, inhaled medications, and exercise. Brensocatib addresses the inflammatory component of the disease, while these other treatments focus on clearing mucus and maintaining airway hygiene.

Dr. Panagis Galiatsatos, a national spokesperson for the American Lung Association, explains that brensocatib won’t fully reverse bronchiectasis, but it can help manage symptoms and potentially slow disease progression. “You want to reduce these exacerbations because they are a burden to a patient,” he says. The medication helps calm inflammation, but it doesn’t clear mucus on its own.

Dosage and Administration

Brensocatib is administered as a once-daily oral pill, available in 10 mg and 25 mg dosages. It can be taken with or without food at any time of day, but consistency – taking it around the same time each day – is recommended. The appropriate dosage will be determined by a healthcare professional based on individual symptoms and quality-of-life goals.

Potential Side Effects and Precautions

Like all medications, brensocatib can cause side effects. The most commonly reported include upper respiratory tract infections, headache, skin issues and rashes, dry or thickening skin, high blood pressure, and gum or dental problems. Nausea and gastrointestinal issues have also been reported, though, as a relatively new medication, the full spectrum of potential side effects is still being evaluated.

Side effects appear to be more frequent with the 25 mg dose compared to the 10 mg dose. Less common side effects include hair loss and abnormal liver blood tests. Because brensocatib lowers part of the immune response, certain precautions are advised. Patients should discuss vaccination schedules with their doctor, as live attenuated vaccines (like those for measles or the flu) may not be recommended. FDA documents also highlight the importance of appropriate infectious control measures, such as masking during peak viral seasons and frequent handwashing, to minimize the risk of infections.

Looking Ahead: Monitoring and Further Research

The approval of brensocatib represents a significant step forward in the treatment of non-cystic fibrosis bronchiectasis. However, ongoing monitoring and further research are crucial. Healthcare professionals will continue to assess the long-term effects of the medication, as well as its impact on different patient populations.

Regular dental checkups (every six months) are also recommended, as the drug’s effect on tissue enzymes may increase the risk of gum disease. The FDA will likely continue to monitor reports of adverse events and update guidance as needed. For individuals living with NCFB, discussing brensocatib with their healthcare provider is an important step in exploring all available treatment options and developing a personalized management plan.