Emerging DPP1 Inhibitors and Closing the Education Gap in Bronchiectasis

In "Emerging DPP1 Inhibitors and Closing the Education Gap in Bronchiectasis," the panel looks ahead to additional DPP1 inhibitors in development and the gaps still limiting bronchiectasis care.

Dr. Basavaraj asks Dr. Metersky about other DPP1 inhibitors currently in development beyond brensocatib. Dr. Metersky describes two additional agents that have completed phase 2 trials, both showing overall results similar to brensocatib, with strong signals for improved exacerbation rates and quality of life. One agent showed a notably more robust reduction in exacerbation rate, he notes, but that trial was conducted exclusively in China, raising the question of whether the stronger effect reflects genuine drug superiority or an Asian-specific treatment response. He points out that even within the ASPEN trial, patients enrolled in Japan showed a more robust response than patients elsewhere, leaving open whether genetics, baseline treatment differences, or underlying disease etiology explain the pattern. Global phase 3 trials will be needed to resolve the question, he says, though both additional DPP1 inhibitors appear promising overall.

Dr. Basavaraj then asks Dr. Khabbaza to identify remaining gaps in bronchiectasis care. Dr. Khabbaza names education as the most significant gap, recalling that his own pulmonary fellowship training included minimal coverage of bronchiectasis, echoed by the sparse sections devoted to the disease in standard board review materials. He acknowledges that his own early management of patients suffered as a direct result of that training gap. He argues for greater emphasis on bronchiectasis within pulmonary fellowship curricula and continuing education, noting that fellows and advanced practice providers seem particularly eager to learn and adjust their practice. Beyond education, Dr. Khabbaza cites the lack of validated biomarkers as a persistent limitation, since clinicians currently have few objective tools to guide treatment duration or assess whether a given therapy is truly working for an individual patient.

In "Bringing Bronchiectasis Guidelines Into Everyday Practice," the panel will discuss what it will take to bring the new CHEST guidelines into routine clinical practice.