Bronchiectasis in the precision medicine era: pathogenesis and therapeutic advances
Xuantao Xia1, Qibiao Wu1,2,3, Zhiyong Cao4
1Faculty of Chinese Medicine, Medical Sciences Division, Macau University of Science and Technology, Macao, China.
None:
Bronchiectasis is a highly heterogeneous chronic respiratory disease. This review aims to summarize recent advancements in pathogenesis and therapeutic strategies within the precision medicine framework, focusing on how individualized approaches to diagnosis and management are replacing conventional "one-size-fits-all" treatments to improve patient clinical outcomes. We synthesized high-level evidence from global registries, such as EMBARC and the BE-China National Prospective Registry, alongside findings from multi-omics research and recent clinical trials. The review evaluates quantifiable biomarkers for endotype-based stratification and assesses mechanism-oriented interventions, including novel targeted therapies and pathogen eradication strategies. Pathogenesis is now conceptualized through the "vicious vortex" model involving persistent infection, dysregulated inflammation, and structural damage. Specific biomarkers, including sputum neutrophil elastase (NE) activity and blood eosinophil counts, allow for the identification of distinct inflammatory endotypes. Notably, the August 2025 Food and Drug Administration (FDA) approval of brensocatib, a dipeptidyl peptidase 1 inhibitor, represents a major milestone in targeted therapy for non-cystic fibrosis bronchiectasis. Furthermore, advancements in understanding the airway resistome and managing multidrug-resistant Pseudomonas aeruginosa have provided robust tools for molecular classification and risk stratification in clinical practice. Bronchiectasis management has shifted from descriptive phenotyping to biomarker-driven endotyping. Transitioning toward mechanism-oriented interventions enables precise clinical decision-making, which is essential for modifying disease progression and reducing the global healthcare burden in the precision medicine era.
Related Concept Videos
COPD: Pathogenesis and Clinical Features
The primary cause for the onset of COPD is cigarette smoking and exposure to air pollution. These hazardous factors initiate a chain reaction within the lungs, resulting in chronic inflammation, damage to the airways, and a...
Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
Cystic Fibrosis: Management
Sinus disease and chronic sinusitis...
Chronic Obstructive Pulmonary Disease III: Chronic Bronchitis Features
Cystic Fibrosis: Pathogenesis
CF is primarily caused by a genetic mutation in a chromosome 7 gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR) protein. The most common gene mutation leading to CF is the ΔF508 mutation, but...
Microorganisms in Medicine and Therapeutics


