New Perspectives in the Treatment of Bronchiectasis

Bronchiectasis is a chronic, heterogeneous respiratory disease. Its pathogenesis involves airway inflammation, chronic infection, impaired mucociliary clearance, and progressive lung damage. Despite recent approval of Brensocatib, current management relies mostly on off-label therapies, highlighting the need for evidence-based strategies. Given the heterogeneity of bronchiectasis, precision medicine approaches that integrate patient phenotypes, endotypes, and disease severity are crucial. Mapping the current landscape of randomized clinical trials (RCTs) highlights the efforts to improve patient outcomes and translate mechanistic insights into clinical practice. This review underscores the shift toward individualized, mechanism-based therapy in bronchiectasis management providing a comprehensive overview of current and emerging therapeutic approaches in bronchiectasis, focusing on ongoing and recent RCTs.