Ashwin Basavaraj, MD, FCCP, ATSF

One year after the US Food & Drug Administration (FDA) approved brensocatib (Brinsupri) as the first disease-modifying therapy for n

 spoke with Ashwin Basavaraj, MD, FCCP, ATSF, on the overlap between this treatment and nontuberculous mycobacteria (NTM) overlap.

 NTM is present in roughly half of US patients with the disease according to data from the US Bronchiectasis and NTM Research Registry and remains an open question for the drug's real-world outcomes.

"NTM is not a contraindication to using DPP-1 inhibitors such as brensocatib, preliminary clinical experience does not suggest worsening of the chronic infectious process with use of these therapies," said Basavaraj, section chief of pulmonary, critical care, and sleep medicine at NYC Health + Hospitals and director of the Bronchiectasis and NTM Program at NYC Health + Hospitals/Bellevue. "We really have to do a deep dive into the data to see what the outcomes are in patients with concurrent NTM and bronchiectasis."

Brensocatib and NTM Overlap in Bronchiectasis, With Ashwin Basavaraj, MD

Basavaraj said brensocatib and other dipeptidyl peptidase-1 (DPP-1) inhibitors target neutrophilic airway inflammation to reduce exacerbations, independent of the chronic infections many patients with bronchiectasis carry. Approval was based on the phase 3 ASPEN trial, which enrolled > 1700 patients and showed both the 10-mg and 25-mg doses reduced annualized exacerbation rates by 20% versus placebo, with the 25-mg dose also slowing lung function decline over 12 months.

 Basavaraj said his group is now collecting data on whether DPP-1 inhibition affects outcomes specifically in patients with concurrent NTM.

NTM Prevalence and Geographic Variation in Bronchiectasis

Basavaraj said the NTM and brensocatib overlap may have a greater prevalence in the United States, while NTM is less prevalent in Europe. He attributed part of the geographic difference to environmental exposure, noting NTM is more common among patients in coastal US states, while Pseudomonas aeruginosa dominates chronic infection patterns in European bronchiectasis cohorts. Basavaraj said water supply differences across regions may contribute to divergent airway microbiome profiles in patients with bronchiectasis, though the mechanism remains unconfirmed.

The disparity carries implications for how DPP-1 inhibitor therapy is studied and applied. Basavaraj said the field needs more outcomes data comparing brensocatib's effect on exacerbations and lung function in patients with and without concurrent NTM before treatment algorithms can fully account for the overlap.

Real-World Diversity and Access to Brensocatib

Basavaraj oversees 2 distinct bronchiectasis populations in New York City: the bronchiectasis program at NYU, where he serves as associate director, and the Bronchiectasis and NTM Program at NYC Health + Hospitals/Bellevue, the public hospital affiliate. The Bellevue cohort includes more Asian and Black patients with bronchiectasis than are typically represented in clinical trial populations, which Basavaraj said underscores the need to enroll broader patient groups in future studies of DPP-1 inhibitors and other emerging therapies.

"We have patients with bronchiectasis who have suffered for years, not knowing where to turn for improvement in their symptoms, and now there is an available therapy where we have seen a dramatic improvement in some patients," said Basavaraj. "Each patient responds differently, but overall, it's exciting there's a new therapy patients can benefit from."

Insmed Incorporated. FDA approves BRINSUPRI (brensocatib) as the first and only treatment for non-cystic fibrosis bronchiectasis, a serious, chronic lung disease. Published August 12, 2025. Accessed August 24, 2026. 

https://investor.insmed.com/2025-08-12-FDA-Approves-BRINSUPRI-TM-brensocatib-as-the-First-and-Only-Treatment-for-Non-Cystic-Fibrosis-Bronchiectasis,-a-Serious,-Chronic-Lung-Disease

HCPLive. One year of brensocatib: how bronchiectasis care has changed. 

https://www.hcplive.com/view/one-year-brensocatib-bronchiectasis-care-has-changed

. Published August 13, 2026. Accessed August 24, 2026.

Drysdale M, Choate R, Brunton AE, et al. Nontuberculous mycobacterial (NTM) infections in bronchiectasis patients: A retrospective US registry cohort study. 

Chalmers JD, Metersky M, Aliberti S, et al. Phase 3 trial of the DPP-1 inhibitor brensocatib in bronchiectasis. 

Videos

One year after FDA approval, Basavaraj discusses NTM overlap, geographic variation, and real-world access in bronchiectasis care.

One Year Later: How Brensocatib Has Changed Bronchiectasis Care

On August 12, 2025, the United States Food and Drug Administration 

approved Insmed’s brensocatib (Brinsupri)

, marking the first disease-modifying therapy for non–cystic fibrosis bronchiectasis.

The approval, based on the phase 3 ASPEN trial enrolling more than 1700 patients, showed that both the 10-mg and 25-mg doses of brensocatib—an oral, reversible inhibitor of dipeptidyl peptidase-1 that dampens neutrophil-driven airway inflammation—reduced annualized exacerbation rates by 20% compared with placebo, with the higher dose also slowing lung function decline over 12 months.

 spoke with 2 pulmonologists who have been prescribing the therapy since its approval about what has changed in day-to-day management of a disease that, until recently, had no targeted treatment options at all.

Mark L. Metersky, MD, FCCP, FACP, professor of medicine and director of the Center for Bronchiectasis Care at UConn Health, said the drug has been well received by patients, many of whom had followed its development before approval. Most patients report subjective improvement, with less coughing, easier sputum clearance, and less discoloration.

“I think that the study results suggest that even in patients who may not have frequent exacerbations but have poor quality of life due to severe symptoms, that there may be benefit in those patients, although clearly it was not tested in such patients. But if you look at the pathophysiology and the way the drug works, and the results of the studies, it looks promising for patients such as those who have a lot of symptoms,” Metersky said. Also, patients who are rapidly losing lung function, since we know that the higher dose slows down the loss of lung function - those are patients in my mind that should be potential candidates for the drug.”

Ashwin Basavaraj, MD, FCCP, ATSF, section chief of pulmonary, critical care, and sleep medicine at NYC Health + Hospitals and director of the Bronchiectasis and NTM Program at NYC Health + Hospitals/Bellevue, echoed that sentiment, describing the past year as an exciting period for a field that had gone decades without a dedicated therapy.

The 1-year anniversary also followed shortly after the American College of Chest Physicians' first North American clinical practice guideline for adult bronchiectasis, published in 2026, which includes long-term brensocatib among 

 for patients with frequent exacerbations.

 Metersky noted that the guideline fills gaps left by earlier documents produced before the drug's approval, though he emphasized that meaningful unmet needs—chronic cough, sputum burden, and disease progression—persist even with expanded treatment options.

Patient selection remains an evolving question, particularly regarding nontuberculous mycobacteria (NTM), which Basavaraj noted affects roughly half of bronchiectasis patients in the US, a substantially higher proportion than in Europe. While NTM is not a contraindication to DPP-1 inhibitor therapy, and Basavaraj reported no signal of worsening infection with brensocatib use, he stressed that outcomes data in this overlapping population are still being collected. Notably, brensocatib's development in other inflammatory indications has not been uniformly successful: a phase 2b trial in hidradenitis suppurativa failed to meet its efficacy endpoints in 2026, leading the manufacturer to discontinue that program, underscoring that its benefit to date is specific to bronchiectasis.

On tolerability, Metersky said the drug's distinctive adverse event profile—including periodontal and skin changes—has not been a significant barrier to uptake in his practice, with the phase 3 trial data showing no significant periodontal disease signal and skin changes remaining uncommon. One year on, both physicians describe a field that has gained its first genuine treatment option, alongside a clearer, though still incomplete, picture of who benefits most.

Basavaraj and Metersky’s disclosures include Insmed and others. 

FDA approves first bronchiectasis therapy, brensocatib, for ages 12 and up. HCPLive. Accessed August 11, 2026. 

https://www.hcplive.com/view/fda-approves-first-bronchiectasis-therapy-brensocatib-12-up

CHEST guideline 2026: 13 recommendations for non-CF bronchiectasis. HCPLive. Accessed August 11, 2026. 

https://www.hcplive.com/view/chest-guideline-2026-13-recommendations-bronchiectasis

Brensocatib phase 2b study in HS does not meet endpoints, program discontinued. HCPLive. Accessed August 11, 2026. 

https://www.hcplive.com/view/brensocatib-phase-2b-study-hs-does-not-meet-endpoints-program-discontinued

Mark Metersky, MD, and Ashwin Basavaraj, MD, discuss novel therapy brensocatib on the 1-year anniversary of its FDA approval.

In "The Future of Bronchiectasis Care: Precision Medicine Ahead," the panel closes the series with its outlook on where bronchiectasis care is headed next.

The Future of Bronchiectasis Care: Precision Medicine Ahead

In a closing round, Dr. Basavaraj asks each panelist what excites them most about the future of bronchiectasis care. Dr. Metersky points to two converging trends: increasing incidental diagnosis through imaging obtained for unrelated reasons, and growing general awareness of the disease, both of which should allow earlier intervention before patients become severely symptomatic. He also highlights a robust and diverse therapeutic pipeline, spanning anti-inflammatory agents, novel biofilm-targeting compounds, and monoclonal antibodies directed at bacteria, alongside growing understanding of disease endotypes.

Dr. ElMaraachli emphasizes that the success of DPP1 inhibition validates an entirely new therapeutic strategy: targeting the underlying pathophysiology of bronchiectasis rather than only managing its consequences. He believes this validation has opened the door for the additional anti-inflammatory therapies currently in earlier-phase development. He also highlights a broader shift in clinical thinking, from simply confirming a bronchiectasis diagnosis toward characterizing which endotype a given patient has, moving the field closer to genuinely personalized, precision-based treatment selection.

Dr. Khabbaza says he is encouraged simply by how much more bronchiectasis is discussed across medicine now, crediting recent educational campaigns around brensocatib's launch with raising awareness among providers. He compares the trajectory to asthma and COPD, fields where multiple biologic options eventually allowed clinicians to target specific inflammatory pathways, and expresses hope that treating inflammation earlier, whether eosinophilic or neutrophilic, may ultimately modify long-term disease course.

Dr. ElMaraachli adds that the growing bronchiectasis and NTM care center network represents an important parallel effort to standardize care delivery worldwide. Dr. Metersky closes by noting that brensocatib's approval matters beyond its individual efficacy, since it demonstrates a viable regulatory pathway for bronchiectasis drugs after years of high-profile late-phase failures had discouraged pharmaceutical investment in the space.

Thank you for watching this HCPLive Peer Exchange series on bronchiectasis. Please subscribe to our eNewsletter for information on upcoming video series.

A more precise, endotype-driven understanding of bronchiectasis, paired with an expanding treatment pipeline, is reshaping expectations for what long-term disease control can look like.

"Bringing Bronchiectasis Guidelines Into Everyday Practice" takes up the practical hurdles of translating new bronchiectasis guidelines into day-to-day patient care.

Bringing Bronchiectasis Guidelines Into Everyday Practice

Dr. Basavaraj asks Dr. Khabbaza what challenges he anticipates in translating the new CHEST guidelines into everyday clinical practice. Dr. Khabbaza notes that a gap between guideline publication and routine bedside adoption is typical of any new guidance, and he expects the underlying knowledge gap to remain a central obstacle. He observes that even patients correctly labeled with bronchiectasis are sometimes still managed as though they have asthma or COPD, reflecting treatment inertia that persists even once terminology improves. He credits growing patient and provider awareness, including direct-to-consumer education, with moving the field in the right direction, but cautions that many clinicians lack hands-on experience with newer modalities such as inhaled antibiotics or tranexamic acid, which involve more operational complexity than writing a standard prescription. He recommends that community physicians partner with bronchiectasis care centers for initial guidance while directly managing components themselves to build practical experience over time.

Dr. Metersky adds that reducing the burden on physicians is equally important to successful implementation. He points to time-intensive tasks such as patient education for airway clearance and prior authorization paperwork, both of which can be delegated to a nurse practitioner or respiratory therapist and dedicated nursing staff, freeing physicians to focus where their expertise is most needed. Dr. Khabbaza adds that portal-delivered educational videos are a valuable adjunct, allowing patients and families to review material together outside the office visit.

Dr. Basavaraj notes that published guidelines are inherently limited to what available evidence supports, and highlights the Bronchiectasis and NTM Association's planned clinical consensus statements as a complementary resource. Dr. ElMaraachli frames these statements as practical, experience-based guidance from high-volume centers addressing questions where formal evidence remains too thin to support a guideline recommendation.

Up next, in the final episode, "The Future of Bronchiectasis Care: Precision Medicine Ahead," the panel shares its outlook on the future of bronchiectasis care.

Turning new bronchiectasis guidelines into everyday practice demands more than awareness, requiring hands-on familiarity with unfamiliar therapies and dedicated staff to share the treatment burden.

Ashwin Basavaraj, MD, FCCP, ATSF

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