Bronchiectasis care is changing. For years, treatment focused on airway clearance, infection control and preventing flares. In 2025, targeted medicines are arriving, with more in late-stage research. This guide explains how the key emerging treatments for bronchiectasis work, who might benefit, and how they fit alongside standard UK care.
The big news: the first approved drug class for Bronchiectasis
In 2025, the US FDA approved brensocatib (brand name BRINSUPRI™) as the first treatment for non-cystic fibrosis bronchiectasis. Two tablet strengths, 10 mg and 25 mg, gained approval after a large Phase 3 trial showed fewer exacerbations than placebo. UK regulators are reviewing the medicine, and NICE has scheduled an appraisal. UK availability will depend on MHRA authorisation and a subsequent NICE recommendation for NHS use.
Brensocatib (BRINSUPRI™): turning down neutrophil “on-switches”
How it works (simple): Neutrophils help you fight infection. Inside them, an enzyme called DPP-1 switches on powerful proteases. In many people with bronchiectasis, these proteases remain overactive and damage airway tissue. Brensocatib blocks DPP-1, so fewer proteases activate. That calms neutrophil-driven inflammation that fuels cough, sputum and flares.
What the evidence shows: In the Phase 3 ASPEN study with over 1,700 participants, brensocatib reduced the annualised exacerbation rate compared with placebo at both doses. Safety looked acceptable within the trial setting. These data underpinned FDA approval and suggest brensocatib may also slow lung function decline modestly.
How it may help you: If you still have frequent flare-ups despite good daily care, brensocatib may reduce exacerbation number and severity and smooth symptoms between flares. In the UK, your team will weigh potential benefits and adverse effects and track MHRA and NICE decisions that determine local access.
Benralizumab (targets eosinophils): for a Type-2/eosinophilic pattern
How it works: Some people with bronchiectasis show a Type 2 / eosinophilic pattern, often alongside severe asthma. Benralizumab is a monoclonal antibody that binds the IL-5 receptor on eosinophils and tags them for removal. Blood and tissue eosinophils fall to very low levels. In the right phenotype, this can reduce airway swelling, mucus and attacks.
Where the research stands in 2025: A dedicated Phase 3 bronchiectasis study is testing whether benralizumab on top of usual care reduces exacerbations in eosinophilic non-CF bronchiectasis. Smaller mechanistic studies support the approach, but results in COPD do not automatically apply to bronchiectasis. For now, benralizumab is not a licensed bronchiectasis treatment, and use should be confined to trials or highly selected cases under specialist advice.
How it may help you: If your blood or sputum eosinophils are raised, you may fit this phenotype. Your specialist can check counts and discuss trial enrolment where available.
Ensifentrine (inhaled dual PDE3/4 inhibitor): bronchodilation plus anti-inflammation
How it works: Ensifentrine is inhaled and has two actions. Blocking PDE3 relaxes airway muscle (bronchodilation). Blocking PDE4 dampens airway inflammation and may aid mucus clearance. Because you inhale it, the lungs see high levels with low body-wide exposure.
Where the research stands in 2025: A Phase 2 bronchiectasis trial is underway to test effects on symptoms, lung function and exacerbations using nebulised ensifentrine 3 mg twice daily over at least 24 weeks. Ensifentrine already has approval for COPD in the US, but bronchiectasis evidence is pending.
How it may help you: If breathlessness, cough and sticky mucus limit your day-to-day life, ensifentrine could—if trials are positive—ease symptoms while also calming inflammation without steroids. Ask your team about research sites and whether you could take part.
Inhaled murepavadin: a precision anti-Pseudomonas antibiotic
How it works: Murepavadin targets Pseudomonas aeruginosa by binding LptD, a protein the bacterium needs to build its outer membrane. Block LptD and the bacterium can’t maintain its protective wall. The inhaled formulation aims to deliver high drug levels straight into airway biofilms while keeping blood levels low.
Where the research stands in 2025: The inhaled programme is in early-phase development for bronchiectasis, with supportive first-in-human data and ongoing studies. It remains investigational.
How it may help you: If you live with chronic or resistant Pseudomonas, inhaled murepavadin could, in time, offer strong, targeted killing where bacteria hide. Access is currently through clinical studies; your centre can advise.
Bacteriophage (“phage”) therapy: personalised viruses that attack bacteria
How it works: Phages are viruses that infect bacteria. A laboratory matches phages to your exact bacterial strain (for example, your Pseudomonas isolate). You then inhale a tailored phage mix so it can infect and burst the bacteria in your lungs. Because phages replicate at the infection site, their effect can persist while the target bacteria remain.
What the evidence shows (2025): Small human studies and case series in chronic airway infections, including Pseudomonas, report reduced sputum bacterial load and improved lung function after nebulised phage therapy added to standard care. Large, bronchiectasis-specific trials are still needed to define who benefits most, how best to dose, and how to avoid resistance. Compassionate-use programmes exist in selected centres.
How it may help you: If you have multidrug-resistant Pseudomonas and few antibiotic options, your team can discuss trial referral or compassionate use where appropriate.
Inhaled antifungals for Aspergillus-related disease (opelconazole/PC945)
How it works: Opelconazole (PC945) is a novel triazole antifungal designed for inhalation. It concentrates in the lungs and stays there, with low blood levels. It blocks ergosterol synthesis, which fungi need to build their cell membranes. High lung levels aim to deliver strong local antifungal effects with fewer systemic side effects and fewer drug–drug interactions.
Where the research stands in 2025: Phase 2 safety data in lung-transplant recipients suggest the inhaled drug is generally well tolerated as prophylaxis. Phase 3 studies are in progress for chronic aspergillosis and prophylaxis in high-risk groups. For people with bronchiectasis and Aspergillus-related disease, such as colonisation or ABPA, opelconazole remains specialist-only and investigational pending further results and approvals.
How it may help you: If Aspergillus worsens cough, wheeze and sputum, targeted inhaled antifungal therapy could, in future, control symptoms with fewer systemic issues than oral azoles. Expect access through specialist centres and clearly defined phenotypes as evidence grows.
How these options sit alongside current UK care
These therapies add to, not replace, the basics:
- Daily airway clearance (physiotherapy), exercise/pulmonary rehab, and vaccinations
- Prompt treatment of exacerbations
- Managing reflux, rhinitis/sinusitis, and smoking cessation
- Macrolides or inhaled antibiotics when indicated
Where the new options fit:
- Brensocatib targets neutrophil-driven inflammation across many patients and now has US approval while UK review continues. It is likely to be used for the management of bronchiectasis in people with 2 or more exacerbations and / or disease progression.
- Benralizumab may be beneficial people with bronchiectasis and eosinophilic disease.
- Ensifentrine could, if trials are positive, improve breathlessness and mucus while calming inflammation in bronchiectasis.
- Murepavadin and phages focus on hard-to-treat bacteria, especially Pseudomonas and may in the future be more accessible.
- Opelconazole targets Aspergillus-related disease under and could be used for hard to treat chronic pulmonary aspergillosis under specialist care
Your respiratory team will tailor choices to your phenotype, microbiology, lung function and flare history, and can advise on clinical trial enrolment where available.
Conclusion
For the first time, we have a medicine that targets a core inflammatory driver of bronchiectasis with convincing Phase 3 data and US approval. Several adjacent strategies may be available in the new future subject to trial results and regulatory approvals (e.g eosinophil-directed biologics, dual PDE3/4 inhibition, precision anti-Pseudomonas antibiotics, bacteriophages and inhaled antifungals). The emerging treatments for bronchiectasis are about personalisation: matching therapy to your inflammatory pattern and microbes while keeping the foundations of care strong. The future sounds promising.
GET IN TOUCH
Schedule a Visit with Dr Jose
For an assessment of your diagnosis and treatment.
Disclaimer: The information provided in this article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment, and is not an advertisement for medical products. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment. Your healthcare professional can assess your individual circumstances. Consultation does not guarantee suitability for any specific treatment; all clinical decisions follow an individual assessment and shared decision-making