Meeting Summary
Non-cystic fibrosis bronchiectasis (NCFB) is a heterogeneous disease characterised by a ‘vicious vortex’ of pathophysiological processes, with neutrophilic inflammation serving as one of the key drivers. NCFB can lead to exacerbations that substantially impact patients’ quality of life and place a considerable burden on healthcare systems. This year, 2025, Insmed Incorporated presented real-world evidence (RWE) at the american Thoracic society (ATS) International Conference in San Francisco, California, USA, and the European Respiratory Society (ERS) Congress in Amsterdam, the Netherlands. The presenters highlighted the unmet needs in global treatment patterns of NCFB, the high hospitalisation burden amongst patients with NCFB on standard of care, and risk factors for exacerbations. The updated ERS Clinical Practise Guideline for the Management of Adult Bronchiectasis was also published in 2025 for improved diagnosis and proactive treatment of patients with bronchiectasis at high risk for exacerbations.
A USA study reported that half of patients with NCFB were managed with medications, including corticosteroids, antibiotics, and β-agonists, within 2 years of thier frist health insurance claim. Complications, including respiratory failure requiring hospitalisation, were common, suggesting that with current management strategies, patients with bronchiectasis continue to experience exacerbations.
Hospitalisation data from a separate USA study found that, on admission, 85.6% of patients with NCFB had pulmonary exacerbations, 29.5% had respiratory failure, and 39.8% had a respiratory infection. Hospital stays required medications, including antibiotics, bronchodilators, or corticosteroids in a majority of cases. A third of patients required mechanical ventilation and 17% needed intensive care, incurring high healthcare costs and long-term post-discharge care. Hospital readmissions were also common.
Data from the UK and French cohorts showed that patients who had experienced ≥2 baseline exacerbations were at a markedly higher risk of exacerbations (160% in the UK; 309% in France), especially those with comorbid COPD, asthma, gastro-oesophageal reflux disease (GORD), or heart failure. Japanese data revealed that older patients (≥75 years) had higher hospitalisation rates, long-term macrolide use, and exacerbations requiring intravenous (IV) antibiotics.
In 2025, the ERS published updated treatment guidelines for adults with bronchiectasis. The guidelines are recommendations for proactive NCFB management, providing diagnostic algorithms and recommending timely intervention if exacerbation risk is high. Collectively, these advances will inform strategies to reduce exacerbations and alleviate the healthcare burden of bronchiectasis.
Introduction
Bronchiectasis is a chronic and progressive inflammatory lung disease, characterised by permanent and abnormal dilatation of the bronchi and accompanied by cough, sputum production, and recurrent bronchial infection and exacerbations.1,2 Bronchiectasis that is not associated with cystic fibrosis is also known as NCFB.3
NCFB is a heterogeneous disease that is frequently enough associated with co-morbidities, including asthma, COPD, and non-tuberculous mycobacterial infection, which can make it challenging to diagnose.2,4 The most frequent cause of bronchiectasis is post-infectious, but up to a third of cases are idiopathic.5
The pathophysiology of bronchiectasis has been described as a vicious vortex, driven by inflammation, chronic airway infection, impaired mucociliary clearance, and structural lung damage.3,6 Neutrophils are important in the pathogenesis of bronchiectasis,and are considered to be one of the key drivers in disease severity and progression.3,6
NCFB is associated with high disease burden on patients and healthcare systems, often pres
## Real-World Data Provide Novel Insights
Currently, the primary management goals of bronchiectasis focus on symptom control and reducing exacerbation frequency to improve health-related quality of life.11 However, the clinical heterogeneity of the condition and limited treatment options available create challenges for clinicians and patients alike. Real-world data on clinical outcomes and treatment patterns for NCFB are providing novel insights that will enhance understanding of bronchiectasis management practices and help to identify more effective approaches.During 2025, several retrospective studies of bronchiectasis patient data were presented at international conferences, including ATS 2025 and ERS 2025,22,23 providing new data on treatment patterns, complications, and hospitalisations.
## Exacerbation Risk Factors
An exacerbation in bronchiectasis is defined as a person with bronchiectasis experiencing deterioration in three or more key symptoms for at least 48 hours, combined with a clinicianS determination that a change in bronchiectasis treatment is required. Core symptoms of exacerbation include a change in cough, sputum volume and/or consistency, sputum purulence, dyspnoea and/or exercise intolerance, fatigue or malaise, and haemoptysis.2 Additional clinical features can indicate a severe exacerbation requiring hospitalisation or IV antibiotic treatment.11
Approximately half of patients with bronchiectasis experience at least two exacerbations per year, and these have a significant impact on patient quality of life, clinical outcomes, and healthcare resources.24
### Morbidity and Exacerbations in Patients with Non-cystic Fibrosis Bronchiectasis in the UK and France
Two retrospective studies that explored patient data from The Health Improvement Network (THIN®, London, UK) UK and France databases23 defined exacerbations as primary care physician visits with codes for exacerbations, haemoptysis, lower respiratory tract infection, or antibiotic prescription with either bronchiectasis or ≥1 lower respiratory tract infection symptom.23 A total of 12,106 patients were included in the UK study and 6,194 in the France study,of whom 15.5% and 12.5%, respectively, experienced ≥2 exacerbations during the baseline period based on this database. Data analysis revealed that patients experiencing ≥2 exacerbations during the baseline period were significantly more likely to have comorbidities such as asthma, COPD, GORD, and heart failure compared to those with <2 exacerbations.23
Approximately 70% of patients in the UK and 75% of patients in France with ≥2 exacerbations during the baseline period experienced a subsequent exacerbation within the first year of follow-up. In contrast, in patients who had <2 exacerbations during baseline, 30% and 25% of patients in the UK and France cohorts had a subsequent exacerbation during the follow-up period. Further analysis of the data de
People with non-cystic fibrosis bronchiectasis (NCFB) often experience serious health problems, including breathing failure (22.0%), heart failure (19.6%), the need for a lung transplant, and repeated worsening of bronchiectasis symptoms.22
Table 1: Complications and all-cause mortality during follow-up.17
*Continuous enrollment or clinical activity were not required during follow-up.
More real-world data on how doctors treat NCFB comes from looking back at groups of patients in the THIN® UK and France databases.27,28 These studies showed that patients with two or more worsening symptoms (exacerbations) were more likely to receive medicines like antibiotics (taken by mouth or inhaled), inhaled steroids, oral steroids, medicines to thin mucus, and bronchodilators, either at the start or during treatment, compared to those with fewer symptoms. In the UK, the use of long-term antibiotics stayed about the same between 2018-2022 for patients with two or more exacerbations, with about one in four patients getting these medicines (23.8% and 24.5%, respectively).23 In France, antibiotic prescriptions went down over time for patients with two or more exacerbations, from 91.9% of patients in 2018 to 80.4% in 2022. Though, the use of long-term antibiotics remained fairly stable during the same time (15.5% and 13.5% in 2018 and 2022, respectively).23 This shows how complex it is to treat NCFB because everyone is diffrent. Frequently enough changing antibiotics, relying on many medicines to treat symptoms and steroids, and continuing to have exacerbations suggest current treatments often don’t fully control bronchiectasis and prevent problems.22
Hospitalizations and Implications for Healthcare Costs
Another study looked at patient data from the USA Premier Healthcare database (Premier Inc., Charlotte, North Carolina, USA). It included 73,656 patients aged 12 years or older (average age: 71.8±14.7 years; 58.3% female) who were hospitalized between January 1st, 2018-June 30th, 2022, and had been diagnosed with bronchiectasis.