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Breaking the Cycle in NCFBE
Breaking the Cycle in NCFBE: A Call to Action for Better Integrating Evidence and Patient-Centered Care in Clinical Practice

Released: April 24, 2025

Expiration: April 23, 2026

Anne E. O'Donnell
Anne E. O'Donnell, MD
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Key Takeaways
  • Non–cystic fibrosis bronchiectasis (NCFBE) is a chronic lung disease that continues to be underdiagnosed, leading to disease progression and impaired quality of life for patients.
  • Although treatment advancements are forthcoming, healthcare professionals must prioritize multidisciplinary care for patients with NCFBE so that all aspects of the disease can be effectively managed.
  • Patient-reported outcomes inform healthcare professionals on patient preferences and help guide treatment planning, yet they are underutilized in clinical practice.   

As the pulmonary community prepares for the 2025 American Thoracic Society International Conference (ATS 2025), we have a timely opportunity to reignite focus on a complex and often underrecognized condition: non–cystic fibrosis bronchiectasis (NCFBE). This commentary is intended to provide more than a clinical update; it highlights a call to action to place patients’ experiences at the heart of every treatment decision and recognize that treatment optimization requires more than simply managing symptoms. Managing NCFBE demands a deep understanding of the burden patients carry and commitment to individualized and evidence-based strategies that reflect the latest in scientific progress.

What Is NCFBE?
NCFBE is a chronic, heterogeneous lung disease that continues to be underdiagnosed despite its significant impact on patients. For many, the journey to diagnosis is prolonged and frustrating, characterized by misattributions of symptoms, repeated infections, and an eventual realization that something more persistent is occurring. Daily symptoms like chronic cough, sputum production, fatigue, and breathlessness often interfere with patients’ work, relationships, and quality of life. Yet these burdens are not always visible through traditional diagnostic lenses. Although chest computed tomography can confirm an NCFBE diagnosis, it does not capture how the disease affects each patient personally. That insight is only enlightened when healthcare professionals (HCPs) make a deliberate effort to assess disease burden and include the patientcare plan development.

The current understanding of NCFBE recognizes it as a disease rooted in a self-perpetuating cycle of impaired mucociliary clearance, chronic infection, inflammation, and structural lung damage. These pathophysiologic mechanisms are tightly interwoven and often reinforce one another, resulting in progressive disease. Breaking this cycle is the cornerstone of modern NCFBE management. However, treatment decisions cannot be made in a vacuum. The heterogeneity of the disease means that no 2 patients are alike, and their care must reflect this complexity.

Advances in NCFBE Management
Recent advances have clarified key treatable traits that can guide therapy. For example, chronic infection with pathogens, such as Pseudomonas aeruginosa, and underlying immunodeficiency are well-recognized contributors, while eosinophilic airway inflammation is an emerging area of interest that may inform a more tailored treatment approach in select patients. Current evidence supports the use of inhaled antibiotics for patients with chronic infection, long-term macrolide therapy for certain phenotypes, and more aggressive airway clearance strategies for individuals with high sputum burden. As helpful as the guidelines and algorithms can be, they must be balanced with a clinical understanding of each patient. What works for one patient may not work for another, and their preferences, comorbidities, and lived experiences should shape every decision.

Of importance, managing NCFBE requires a multidisciplinary approach that includes pulmonology, infectious disease, immunology, respiratory therapy, pharmacy, and primary care. Care coordination is critical as it can help reduce exacerbations, enhance treatment adherence, and improve long-term outcomes. Further, involving a range of specialists in patients’ care ensures they are seen as a whole person, not just a set of pulmonary-related symptoms.

This is also the time for HCPs to make better use of the tools that assess patient-reported outcomes. Instruments designed to measure their quality of life, level of fatigue, symptom burden, and activity limitations are underutilized in clinical practice, yet they are essential for capturing what matters most to patients. Patient-reported outcomes should be used to guide treatment decisions and foster shared decision-making, which then improves patient satisfaction and treatment adherence.

A Call to Action
As ATS 2025 approaches, I encourage all HCPs involved in the care of patients with NCFBE to reflect on their current practice. Are you assessing patients’ burden thoroughly? Do you align treatment plans with both the patients’ biology and experience? And are you making the most of the latest data to personalize therapy?

The upcoming Clinical Care Options satellite symposium will offer fresh perspectives on the pathophysiology, management, and evolving treatment landscape of NCFBE. But the real impact of that education will come from how we, as HCPs, implement it our practice. Let this be a time to recommit to delivering patient-centered care and ensuring that every patient with NCFBE receives the thoughtful, personalized, and effective care they deserve. 

Your Thoughts
Are you currently making the most of the latest data in NCFBE management to provide personalized therapy? You can get involved in the conversation by answering the poll question and posting a comment below.

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