Emerging pharmacological therapies for bronchiectasis.

INTRODUCTION: Bronchiectasis is a clinical syndrome characterized by dilated and thickened airways paired with clinical symptoms, most commonly a chronic suppurative cough that characteristically exacerbates. The disease can have burdensome symptoms that reduce quality of life. Pharmacologic treatments to date have been few and limited largely to antibiotic therapies. In recent years, bronchiectasis has been reconceived as a primary inflammatory disease, and drug development has since shifted to identify anti-inflammatory and immunomodulatory drugs.

METHODS: We conducted a targeted literature and clinical trial search to identify established and investigational pharmacotherapies for bronchiectasis. Seaches of PubMed, Google Scholar, UpToDate, OpenEvidence, and ClinicalTrials.gov were performed to identify published evidence, ongoing and completed clinical trials, and emerging therapeutic approaches.

AREAS COVERED: Herein, we review existing available therapies for patients with bronchiectasis. We then go on to review novel anti-inflammatory and immunomodulatory drugs as well as non-antibiotic anti-bacterial therapies in the development pipeline. We review drug safety, tolerability, efficacy, adverse reactions and cost considerations of therapy.

EXPERT OPINION: There are many potential treatments under investigation for bronchiectasis newly targeting airway inflammation. The effect size of the newer anti-inflammatory agents will likely be tied to a patient's unique inflammatory endotype. Future research should aim to identify clinically meaningful biomarkers that may allow clinicians to select the therapeutic agent best tailored to their disease.