Non-Cystic Fibrosis Bronchiectasis Market By Treatment Type (DPP1 Inhibitors, Antibiotics, Mucoactive and Airway-Clearance Therapies, Bronchodilators, Corticosteroids, Biologics, Inhaled Immunotherapies, Bacteriophage Therapies, Other Supportive Treatments); By Route of Administration (Oral, Inhaled and Nebulized, Intravenous, Subcutaneous, Others); By Distribution Channel (Hospital Pharmacies, Retail Pharmacies and Drug Stores, Specialty Pharmacies, Online Pharmacies); By Patient Type (Adults, Adolescents Aged 12–17 Years); By Geography, Segment Revenue Estimation, Forecast, 2026–2032

Non-Cystic Fibrosis Bronchiectasis Market - First Approval Moves Bronchiectasis Beyond Supportive Care

The Global Non-Cystic Fibrosis Bronchiectasis Market was valued at USD 2.28 billion in 2025 and is projected to reach USD 6.18 billion by 2032, expanding at a CAGR of 15.3% during 2026–2032, according to Strategic Market Research.

 

Non-cystic fibrosis bronchiectasis is a long-term lung disorder in which damaged airways become permanently enlarged and inflamed, allowing thick mucus to collect and promoting repeated infections. Typical symptoms are a persistent productive cough, breathlessness, and frequent respiratory flare-ups. It can develop after serious infections such as pneumonia or tuberculosis, or from immune deficiencies, primary ciliary dyskinesia, alpha-1 antitrypsin deficiency, ABPA, asthma, COPD, autoimmune disease, airway obstruction, or recurrent aspiration. Despite investigation, the underlying cause remains unknown in a substantial proportion of patients.

 

Brensocatib (Brinsupri) is the first FDA-approved targeted treatment for NCFB in patients aged 12 years and older. It reversibly inhibits DPP1, preventing activation of neutrophil serine proteases and thereby limiting neutrophil-driven airway inflammation and tissue damage. Supportive treatment includes macrolides for antibacterial and anti-inflammatory effects, inhaled or oral antibiotics to control recurrent bacterial infection, hypertonic saline to hydrate mucus and improve clearance, and bronchodilators to relax airway muscles; corticosteroids are generally reserved for accompanying asthma or COPD. HSK31858 is another oral DPP1 inhibitor under clinical investigation to reduce neutrophilic inflammation and pulmonary exacerbations.

 

A Larger Patient Pool Is Emerging From Other Lung-Disease Labels

Recurrent aspiration and dysphagia are key causes of secondary bronchiectasis. About 30% of patients have another aspiration event within a year, and up to 50% develop lower respiratory infections. Hospitalization rates can reach 75% in these patients versus 35% in non-aspirating cases. High-risk groups include patients with stroke, dementia, neurological disorders, severe GERD, or feeding/airway devices, making them heavy users of infection control and airway clearance care.

COPD and asthma represent large overlapping patient pools. COPD affects over 210 million people globally and causes about 3.4 million deaths annually, while asthma affects around 363 million worldwide. Many patients with severe or uncontrolled disease also develop bronchiectasis, increasing demand for better screening and phenotype-based treatment.

Allergic bronchopulmonary aspergillosis (ABPA) is another important cause, affecting about 2.5% of adults with asthma (~4.8 million people globally). Over 90% of patients may experience exacerbations within three years without maintenance therapy, driving use of antifungals, corticosteroids, biologics, and imaging-based monitoring.

Post-tuberculosis lung disease is a major growth driver in high-burden regions. TB affected about 10.7 million people in 2024, with India alone accounting for ~25% of cases. Even after cure, TB often leaves permanent airway damage leading to bronchiectasis, making South Asia, Africa, and Southeast Asia key long-term markets.

Pneumonia and recurrent respiratory infections also contribute significantly to disease development and progression, with pneumonia causing about 2.5 million deaths globally each year, especially in children and older adults.

 

Exacerbations Carry More Commercial Weight Than Daily Symptoms

Repeated pulmonary exacerbations are the main source of clinical and economic pressure. They usually involve worsening cough, increased sputum volume or thickness, fatigue, breathlessness, and declining activity. Oral antibiotics may be sufficient for moderate episodes, while severe infections can require intravenous treatment or hospitalization. Frequent exacerbations are associated with faster lung-function decline, poorer quality of life, and higher mortality, particularly when Pseudomonas aeruginosa is present.

The financial burden rises sharply when exacerbations occur. Published US analyses have placed annual costs at approximately USD 13,244–26,284 for patients without exacerbations, increasing to around USD 37,030 or more when exacerbations are recorded. A separate 2025 analysis reported annual respiratory costs of USD 14,116 among patients with cost-based exacerbations, compared with USD 3,390 among those without them. Hospitalization remains the largest cost component.

 

Multiple Disease Origins Prevent a Single Treatment Model

Bronchiectasis can develop after severe pneumonia, tuberculosis, or other respiratory infections. It may also follow immune deficiencies, autoimmune disease, inherited disorders affecting mucus clearance, or physical blockage of an airway. Yet as many as 38% of cases are classified as idiopathic because no clear cause is identified.

The patient population also has substantial overlap with other chronic conditions. US data indicate gastroesophageal reflux disease in 47% of patients, asthma in 29%, and COPD in 20%. These overlaps influence prescribing because inhaled corticosteroids and bronchodilators are generally used when asthma or COPD is also present rather than as universal bronchiectasis therapies. Older patients may additionally have cardiovascular disease, frailty, or other conditions that affect adherence and tolerance.

Patients with neutrophil-driven inflammation represent the principal market for DPP1 inhibitors. Those with eosinophilic inflammation may be considered for biologic approaches, although evidence in bronchiectasis remains limited. Patients with chronic P. aeruginosa infection create demand for inhaled antibiotics and experimental phage therapies. Post-tuberculosis disease remains particularly relevant in parts of Asia, while immune-deficiency-associated bronchiectasis supports demand for immunology testing and replacement therapies.

 

Brinsupri Converts Unmet Need Into a Billion-Dollar Launch Opportunity

The FDA approved Brinsupri in August 2025 for adults and patients aged 12 years or older with non-cystic fibrosis bronchiectasis. The European Commission approved the medicine in November 2025 for patients in the same age range who had experienced at least two exacerbations during the preceding 12 months. The United Kingdom granted authorization in February 2026, while a Japanese regulatory decision was still expected during 2026 as of the research cut-off.

Brensocatib inhibits dipeptidyl peptidase 1, or DPP1. DPP1 activates neutrophil serine proteases while neutrophils mature in the bone marrow. Excessive protease activity contributes to airway inflammation, mucus production, and tissue damage. By reducing activation of these enzymes, brensocatib targets a central inflammatory pathway rather than treating only the infection or mucus that appears later.

The Phase III ASPEN study enrolled 1,721 patients. Annualized pulmonary exacerbation rates were 1.02 with the 10 mg dose and 1.04 with the 25 mg dose, compared with 1.29 for placebo. The corresponding reductions were approximately 21% and 19%. The trial established clinically meaningful prevention of exacerbations, although it did not eliminate the need for antibiotics or airway-clearance care.

Commercial uptake has been rapid. Insmed reported USD 172.7 million in Brinsupri revenue during 2025 after the US launch in August. Revenue reached USD 207.9 million in the first quarter of 2026, 44% above the fourth quarter of 2025. The company continued to forecast at least USD 1 billion in full-year 2026 revenue. These results indicate that pulmonologists were able to identify and start a meaningful number of eligible frequent-exacerbation patients soon after approval.

 

DPP1 Inhibitors Are Becoming a Competitive Drug Class

Brinsupri’s approval has validated DPP1 as a commercial target, encouraging competitors to develop their own oral inhibitors. The most advanced challenger is HSK31858, now known as florensocatib, from Haisco Pharmaceutical.

In a Phase II trial involving 226 adults, both the 20 mg and 40 mg doses reduced exacerbation frequency compared with placebo. Haisco subsequently advanced the 40 mg dose into the Phase III HOPE-BE trial. The study randomized 700 patients across 67 sites in mainland China, including patients with at least two exacerbations in the previous year. A separate long-term Phase III safety study is recruiting approximately 669 participants.

Florensocatib has strategic importance beyond being another pipeline medicine. Positive Phase III results could establish price and access competition within the DPP1 class, particularly in China and other Asian markets. It may also test whether treatment effects seen with brensocatib can be replicated across different ethnic, clinical, and healthcare settings.

Boehringer Ingelheim is developing BI 1291583, now called verducatib. Phase II research found a reduction in the risk of bronchiectasis exacerbation, leading to the Phase III AIRTIVITY program. The program is evaluating whether another cathepsin C/DPP1 inhibitor can deliver consistent exacerbation prevention with an acceptable long-term safety profile.

The competitive focus is likely to move toward dosing, safety monitoring, price, international availability, and evidence in narrower patient groups. A second approved DPP1 inhibitor would reduce Insmed’s first-mover protection but could expand physician confidence in the class.

 

Infection-Focused Therapies Address Patients Left Outside DPP1 Treatment

CSL Behring’s CSL787 takes a different approach. It is a nebulized immunoglobulin therapy intended to strengthen local airway defense against infection. Phase I findings supported further evaluation, and a dose-ranging Phase II study is assessing two inhaled regimens in adults with non-cystic fibrosis bronchiectasis. An inhaled immune therapy could serve patients whose commercial need is driven by persistent infection rather than uncontrolled neutrophilic inflammation.

Armata Pharmaceuticals’ AP-PA02 is an inhaled bacteriophage cocktail directed against P. aeruginosa, including drug-resistant strains. Its Phase II Tailwind study did not show a significant difference within each small treatment cohort. However, a post-hoc pooled analysis found a statistically significant reduction in bacterial density at days 17 and 24. The findings support further development but do not yet establish reduced exacerbations, hospitalization, or antibiotic use.

Phage therapy has commercial relevance because chronic P. aeruginosa infection is difficult to eradicate and repeated antibiotic exposure increases resistance concerns. Future adoption would depend on reproducible clinical outcomes, reliable manufacturing, pathogen testing, and a practical home-nebulization model.

AstraZeneca’s benralizumab illustrates the difficulty of transferring biologics from asthma into bronchiectasis. The Phase III MAHALE study targeted eosinophilic inflammation but was stopped early because of recruitment challenges. Only 100 patients were randomized, and annualized exacerbation rates were not significantly different between benralizumab and placebo. The result does not support benralizumab as a near-term bronchiectasis competitor, although the study leaves open the possibility that a better-selected eosinophilic subgroup could respond differently.

 

Diagnosis, Coverage, and Patient Selection Will Set the Market Ceiling

The market’s near-term expansion will be driven by three connected changes: more CT-confirmed diagnoses, routine recording of exacerbation history, and greater use of sputum testing to identify chronic infection. Specialist bronchiectasis clinics can accelerate these changes because they combine pulmonology, respiratory physiotherapy, microbiology, and pharmacy support.

Brinsupri’s rapid launch confirms that a high-value treated population exists. Yet the entire estimated US population of 340,000–522,000 treated adults is not an immediate addressable drug market. Eligibility will remain concentrated among frequent exacerbators who have persistent disease despite airway clearance and established preventive therapy.

 

Companies Are Building Positions Across Inflammation and Infection Control

The competitive landscape remains concentrated, with companies following three main development strategies: reducing neutrophilic inflammation, controlling chronic airway infections, and targeting smaller biological subgroups. Insmed currently holds the strongest commercial position because Brinsupri is the first approved disease-specific therapy and the first DPP1 inhibitor available for non-cystic fibrosis bronchiectasis.

Insmed currently leads the bronchiectasis market with Brinsupri, generating strong early revenues and projecting over USD 1 billion in 2026, though high pricing and payer restrictions may limit access. Its position is being challenged by late-stage DPP1 competitors, with Haisco advancing florensocatib in China and Boehringer Ingelheim developing verducatib, both aiming to match or improve on Brinsupri’s ability to reduce exacerbations and strengthen the overall DPP1 treatment class.

Other approaches remain more uncertain. CSL Behring is testing an inhaled immunoglobulin for infection-driven disease, while Armata’s bacteriophage therapy has yet to show clear clinical benefit despite reducing bacterial load. AstraZeneca’s failed benralizumab trial further highlights the difficulty of using broad biologics in bronchiectasis. Overall, the market is currently led by DPP1 inhibitors, with infection-targeted therapies and biologics still seeking proven clinical and commercial impact.

 

Analyst Perspective: Exacerbation Reduction Will Determine Market Leadership

The non-cystic fibrosis bronchiectasis market is shifting from basic supportive care to higher-value preventive treatments. It is expected to grow from USD 2.28 billion in 2025 to USD 6.18 billion by 2032, driven by better diagnosis, more CT use, and improved identification of frequent exacerbators.

Brinsupri is expected to remain a high-value but tightly restricted therapy, mainly used in patients with frequent exacerbations or prior hospitalizations due to its high annual cost of about USD 88,000. Insurers are likely to enforce strict access criteria based on disease severity and prior treatment history.

DPP1 inhibitors will continue to dominate the treatment landscape, with Insmed leading as the first mover, though competition from florensocatib and verducatib could intensify pricing pressure if similar efficacy is demonstrated. At the same time, infection-targeted therapies such as inhaled antibiotics and bacteriophage treatments are emerging for patients with chronic P. aeruginosa infections, but their success will depend on proving meaningful clinical outcomes beyond bacterial reduction. Overall, the market will remain divided between inflammation-focused and infection-control approaches, with commercial success driven by reductions in hospitalizations and antibiotic use.

 

Non-Cystic Fibrosis Bronchiectasis Report Coverage Table

Report Attribute	Details
Forecast Period	2026 – 2032
Market Size Value in 2025	USD 2.28 Billion
Revenue Forecast in 2032	USD 6.18 Billion
Overall Growth Rate	CAGR of 15.3% (2026 – 2032)
Base Year for Estimation	2025
Historical Data	2019 – 2024
Unit	USD Million, CAGR (2026 – 2032)
Segmentation	By Treatment Type, By Route of Administration, By Distribution Channel, By Patient Type, By Geography
By Treatment Type	DPP1 Inhibitors, Antibiotics, Mucoactive and Airway-Clearance Therapies, Bronchodilators, Corticosteroids, Biologics, Inhaled Immunotherapies, Bacteriophage Therapies, Other Supportive Treatments
By Route of Administration	Oral, Inhaled and Nebulized, Intravenous, Subcutaneous, Others
By Distribution Channel	Hospital Pharmacies, Retail Pharmacies and Drug Stores, Specialty Pharmacies, Online Pharmacies
By Patient Type	Adults, Adolescents Aged 12–17 Years
By Region	North America, Europe, Asia-Pacific, Latin America, Middle East and Africa
Country Scope	U.S., Canada, UK, Germany, France, Italy, Spain, China, Japan, South Korea, India, Brazil, Mexico, Saudi Arabia, UAE, South Africa
Market Drivers	First approval of a disease-specific DPP1 inhibitor; rising identification of CT-confirmed bronchiectasis and frequent exacerbators; high hospitalization and antibiotic burden associated with pulmonary exacerbations; expanding post-tuberculosis and COPD-overlap patient pools; growing investment in inflammation- and infection-focused therapies
Customization Option	Available upon request