Bronchiectasis - Market Insight, Epidemiology And Market Forecast - 2034

Key Highlights:

• According to DelveInsight's estimates, in 2023, there were approximately 1,028,651 diagnosed prevalent cases of NCFB in the 7MM. Of these, the US accounted for approximately 37% of the cases, EU4 and the UK countries accounted for around 54%, followed by Japan which represented nearly 9%.
• DelveInsight's estimates indicate that in 2023, there were approximately 77,445 diagnosed prevalent cases of cystic fibrosis bronchiectasis across the 7MM. Of these, the US accounted for about 53.7%, EU4 and the UK made up around 46.3%, and Japan represented nearly 0.1% of cases.
• The bronchiectasis market is set for steady growth, with a robust compound annual growth rate (CAGR) anticipated from 2024 to 2034. This expansion in the 7MM is driven by the introduction of innovative therapies such as Brensocatib, and CMS I-neb, as well as advances in diagnostic techniques and the rising prevalence of bronchiectasis.
• According to DelveInsight's analysis, the bronchiectasis market in the 7MM was valued at approximately USD 1,581.2 million in 2023. Over the forecast period from 2024 to 2034, this market is projected to grow at a CAGR of 13.7%.
• A critical unmet need in bronchiectasis is the lack of approved, disease-specific therapies. Current treatments primarily focus on symptom management rather than addressing the underlying pathology, creating a significant gap in effective long-term solutions and driving demand for targeted, innovative drug development.
• In October 2024, Insmed shared positive late-breaking subgroup data from the Phase III ASPEN study of brensocatib for patients with bronchiectasis at the CHEST 2024 Annual Meeting.

DelveInsight's "Bronchiectasis - Market Insights, Epidemiology, and Market Forecast - 2034" report delivers an in-depth understanding of bronchiectasis, historical and forecasted epidemiology, as well as the bronchiectasis market trends in the United States, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan.

The bronchiectasis market report provides current treatment practices, emerging drugs, market share of individual therapies, and current and forecasted 7MM bronchiectasis market size from 2020 to 2034. The report also covers bronchiectasis treatment practices/algorithms and unmet medical needs to curate the best opportunities and assess the market's potential.

Bronchiectasis Understanding and Treatment Algorithm

Bronchiectasis overview

Bronchiectasis is a chronic, progressive lung disease characterized by irreversible bronchial airway dilation and impaired mucociliary function, resulting in persistent mucus buildup and heightened bacterial colonization. Although historically linked to childhood respiratory infections, the disease is now understood to have multifactorial origins, including idiopathic, acquired, or infection-related causes. A productive cough is the hallmark symptom, yet in nearly 40% of cases, the cause remains unidentified. Bronchiectasis frequently develops secondary to pulmonary conditions such as cystic fibrosis, COPD, autoimmune diseases, immunodeficiencies, and airway obstructions, or through recurrent infections, including pneumonia and tuberculosis. The disease presents with gradually worsening airflow obstruction, marked by chronic cough, thick mucus production, shortness of breath, and systemic signs like fever, fatigue, and chest pain. As the condition advances, complications such as hemoptysis and nail clubbing may arise, underscoring the impact of recurrent infections, airway blockages, and peribronchial fibrosis on disease progression.

Bronchiectasis diagnosis

The diagnosis of bronchiectasis is primarily established through chest computed tomography scans, which provide detailed imaging of bronchial dilation and associated abnormalities. Complementary diagnostic modalities, including chest X-rays, bronchoscopy, lung function tests, blood tests, and sputum cultures, are utilized to identify potential underlying conditions and assess microbial colonization. The definitive diagnostic tool for bronchiectasis is High-Resolution Computed Tomography (HRCT) of the chest, optimally conducted when the patient is clinically stable to ensure accuracy. HRCT provides detailed imaging of the bronchial structure, with tubular bronchiectasis emerging as the most frequently observed subtype. This imaging modality allows for precise identification of bronchial dilation and related abnormalities, facilitating early intervention and improved disease management.

Bronchiectasis treatment

The management of Bronchiectasis centers on identifying and addressing underlying causes, such as prior severe respiratory infections, allergic bronchopulmonary aspergillosis, ciliary clearance impairment, immunodeficiency, COPD, and severe asthma. Treatment strategies focus primarily on symptomatic relief and optimizing lung function through mucus clearance techniques, infection control with antibiotics, and the use of bronchodilators or corticosteroids to alleviate airflow obstruction. Supportive measures, including smoking cessation and vaccinations, play a key role, while advanced cases may require surgical intervention or lung transplantation. However, the absence of disease-modifying therapies highlights a critical gap in treatment, as current approaches primarily manage symptoms without addressing the root causes of Bronchiectasis. Although inhaled corticosteroids and long-term macrolide therapies show promise, efficacy evidence remains limited by small cohorts and brief trial durations, underscoring the urgent need for more robust research to develop targeted therapies capable of reversing structural damage and improving long-term patient outcomes.

Bronchiectasis Epidemiology

As the market is derived using a patient-based model, the bronchiectasis epidemiology chapter in the report provides historical as well as forecasted epidemiology segmented by total diagnosed prevalent cases of NCFB, gender-specific diagnosed prevalent cases of NCFB, severity-specific diagnosed prevalent cases of NCFB, etiology-specific diagnosed prevalent cases of NCFB, microbiology of NCFB patients, total diagnosed prevalent cases of cystic fibrosis bronchiectasis, gender-specific diagnosed prevalent cases of cystic fibrosis bronchiectasis, age-specific diagnosed prevalent cases of cystic fibrosis bronchiectasis, and microbiology of cystic fibrosis bronchiectasis patients in the 7MM covering the United States, EU4 countries (Germany, France, Italy, and Spain) and the United Kingdom, and Japan from 2020 to 2034.

• According to DelveInsight's epidemiology model, in the 7MM, the total diagnosed prevalent cases of NCFB were approximately 1,028,651 in 2023. This number is anticipated to rise during the forecast period (2024-2034), driven by increased awareness and screening, along with advancements in diagnostic techniques.
• In 2023, the US accounted for the highest number of diagnosed prevalent cases of NCFB, with approximately 380,711 cases, while France accounted for the least, with only 37,576 cases.
• Among EU4 and the UK, the UK accounted for the highest number of diagnosed prevalent cases of NCFB, with approximately 224,976 cases in 2023, followed by Spain with approximately 149,236 cases, and Italy with nearly 89,584 cases.
• Among the severity-specific diagnosed prevalent cases of NCFB in EU4 and the UK in 2023, there were approximately 235,481 moderate cases, around 163,649 severe cases, and 152,230 mild cases.
• Among the gender-specific cases of NCFB in the UK in 2023, there were approximately 130,486 cases for females and around 94,490 cases for males.
• In Japan in 2023, the majority of etiology-specific diagnosed prevalent cases of NCFB were attributed to other pathogen, accounting for 46,600 cases.
• In 2023, among the 7MM, Japan had approximately 96,580 diagnosed prevalent cases of NCFB.
• In 2023, among the 7MM, the US accounted for the highest number of diagnosed prevalent cases of cystic fibrosis bronchiectasis, with approximately 41,566 cases, while Japan accounted for the least, with only 59 cases.
• Among the gender-specific cases of cystic fibrosis bronchiectasis in EU4 and the UK in 2023, there were approximately 17,081 cases for females and around 18,738 cases for males.
• Among the age-specific cases of cystic fibrosis bronchiectasis in Japan in 2023, there were approximately 24 cases for children and around 36 cases for adult.
• In 2023, the majority of etiology-specific diagnosed prevalent cases of cystic fibrosis bronchiectasis in Japan were attributed to Staphylococcus aureus, accounting for 36 cases.

Bronchiectasis Drug Chapters

Emerging Drugs

Brensocatib: Insmed/AstraZeneca

Brensocatib, an oral small-molecule inhibitor targeting dipeptidyl peptidase 1 (DPP1), is being developed by Insmed for the treatment of bronchiectasis, CRSsNP, and other neutrophil-driven conditions. By inhibiting DPP1, brensocatib aims to reduce inflammation by blocking the activation of neutrophil serine proteases (NSPs), such as neutrophil elastase, during neutrophil formation in the bone marrow. Insmed reported positive topline results from the Phase III ASPEN study of brensocatib in patients with bronchiectasis, leading to plans for a New Drug Application (NDA) submission to the US FDA in late 2024. If approved, brensocatib is expected to launch in the US by mid-2025, followed by launches in Europe and Japan in the first half of 2026. In October 2024, Insmed shared positive late-breaking subgroup data from the Phase III ASPEN study of brensocatib for patients with bronchiectasis at the CHEST 2024 Annual Meeting. Furthermore, the EMA approved a Pediatric Investigational Plan for brensocatib in bronchiectasis patients, and brensocatib has gained access to the PRIME scheme and Breakthrough Therapy Designation for adult bronchiectasis patients.

Inhaled Colistimethate Sodium (CMS I-neb): Zambon

CMS I-neb is an investigational inhaled therapy for adults with bronchiectasis colonized by P. aeruginosa, potentially offering a first-in-class treatment option. It uses colistimethate sodium, a prodrug of colistin, a polymyxin antibiotic targeting aerobic Gram-negative pathogens, including drug-resistant P. aeruginosa. By disrupting the bacterial cell membrane, colistin causes cell death and serves as a last-resort treatment for infections like carbapenem-resistant P. aeruginosa. In September 2024, Zambon released the results of the Phase III PROMIS-I and PROMIS-II studies in The Lancet Respiratory Medicine journal. The Phase III PROMIS-I trial demonstrated a significant reduction in pulmonary exacerbation rates. Although the PROMIS-II trial was terminated early due to the pandemic, pre-pandemic data showed consistency with PROMIS-I outcomes. Zambon is working with regulatory authorities to expedite patient access. The US FDA has granted CMS I-neb Breakthrough Therapy Designation (BTD), as well as QIDP and Fast Track Designation (FTD).

FASENRA (benralizumab): AstraZeneca

FASENRA (benralizumab) is a monoclonal antibody that targets the IL-5 receptor alpha on eosinophils, facilitating the recruitment of natural killer cells to induce apoptosis, resulting in rapid and near-complete depletion of blood and tissue eosinophils in most patients. FASENRA is currently under investigation for treating adult patients with NCFB associated with eosinophilic inflammation (bronchiectasis + EI). According to clinicaltrials.gov, FASENRA completed Phase III clinical trials for this indication in April 2024.

Drug Class Insights

The treatment of bronchiectasis involves several drug classes tailored to manage symptoms, reduce exacerbations, and control underlying inflammation. Antibiotics, both oral and inhaled, are essential for managing chronic bacterial colonization, particularly against pathogens like P. aeruginosa. Macrolides, often used for their anti-inflammatory properties, are beneficial in reducing exacerbation frequency. Bronchodilators, including beta-agonists and anticholinergics, help alleviate airway obstruction, while corticosteroids are used to address inflammation, although their role remains limited due to potential side effects. Mucolytic agents improve mucus clearance, and emerging anti-inflammatory agents targeting neutrophilic inflammation, such as DPP1 inhibitors, represent innovative approaches. Together, these drug classes form a comprehensive yet evolving treatment landscape for bronchiectasis, addressing its multifaceted pathophysiology.

Market Outlook

The market for bronchiectasis is poised for significant growth due to the evolving landscape of pharmacological and non-pharmacological interventions addressing the complex pathophysiology of the disease. Current therapeutic strategies encompass a range of treatment options which includes medications, chest physical therapy, hydration, and in severe cases, oxygen therapy with inhaled antibiotics demonstrating efficacy in managing chronic bacterial infections and reducing exacerbation rates. Emerging therapies, such as Brensocatib, a Dipeptidyl Peptidase 1 (DPP1) inhibitor, and BI 1291583, a cathepsin C inhibitor, target neutrophilic inflammation through distinct mechanisms, thereby offering novel approaches to improve patient outcomes. Additionally, investigational therapies like CMS I-neb and monoclonal antibodies such as FASENRA and Itepekimab present further options by directly targeting specific inflammatory pathways associated with eosinophilic inflammation. The incorporation of non-pharmacological approaches, particularly Airway Clearance Techniques (ACTs), complements pharmacological regimens, enhancing mucus clearance and preventing infection. However, the market faces challenges, including a lack of consensus guidelines and under-researched therapies like mucolytics and hyperosmolar agents, which may hinder optimal patient management.

Nonetheless, ongoing clinical trials and advancements in drug development highlight the potential for innovative treatments to fill existing gaps in bronchiectasis management, ultimately improving the quality of life for patients and reducing the burden on healthcare systems. With a promising pipeline of therapies in various stages of development, the future of bronchiectasis treatment appears increasingly optimistic, underscoring the need for continued research and clinical validation to fully realize these opportunities.

Key players Insmed, Zambon, AstraZeneca, Renovion, Sanofi, and others are evaluating their lead candidates in different stages of clinical development. They aim to investigate their products to treat bronchiectasis.

• The total market size of bronchiectasis in the 7MM was approximately USD 1,581.2 million in 2023 and is projected to increase during the forecast period (2024-2034), with a CAGR of approximately 10.2%.
• The total market size of bronchiectasis in the US was approximately USD 740.9 million in 2023, accounting for approximately 47% of the total market revenue for the 7MM.
• The total market size of bronchiectasis in EU4 and the UK was calculated to be approximately USD 772.5 million in 2023. Among the EU4 and the UK, the UK accounted for the highest market with approximately USD 310.5 million, followed by Spain with approximately USD 199.4 million in the respective year, and Italy with nearly USD 126.3 million.
• The total market size of bronchiectasis in Japan was approximately USD 67.9 million in 2023.
• Among the currently used therapies, the majority of the market share was of Bronchodilators, with a revenue of approximately USD 1,096.8 million in 2023 among the 7MM.

Bronchiectasis Drugs Uptake

This section focuses on the uptake rate of potential drugs expected to be launched in the market during 2020-2034. For example Brensocatib is expected to enter the US market in 2025 and is projected to have a medium-fast uptake during the forecast period.

Bronchiectasis Pipeline Development Activities

The report provides insights into different therapeutic candidates in Phase III, Phase II, and Phase I. It also analyzes key players involved in developing targeted therapeutics.

Pipeline development activities

The report covers information on collaborations, acquisitions and mergers, licensing, and patent details for emerging therapies for bronchiectasis.

KOL Views

To keep up with current market trends, we take KOLs and SMEs' opinions working in the domain through primary research to fill the data gaps and validate our secondary research. Industry Experts contacted for insights on bronchiectasis evolving treatment landscape, patient reliance on conventional therapies, patient therapy switching acceptability, and drug uptake, along with challenges related to accessibility, including Medical/scientific writers, Medical Professionals, Professors, Directors, and Others.

DelveInsight's analysts connected with 50+ KOLs to gather insights; however, interviews were conducted with 15+ KOLs in the 7MM. Centers like the University of Chicago, Chicago, USA, Georgetown University Hospital, Washington, DC, US, Hospital Universitari Vall d'Hebron, Barcelona, Spain, and the Fukujuji Hospital, Tokyo, Japan, among others, were contacted. Their opinion helps understand and validate current and emerging therapy treatment patterns or bronchiectasis market trends. This will support the clients in potential upcoming novel treatments by identifying the overall scenario of the market and the unmet needs.

Physician's View

As per the KOLs from the US, Exacerbations are critical events in the course of bronchiectasis, often triggered by bacterial or viral infections. Beyond worsening symptoms, they can significantly reduce quality of life, impair lung function, and increase the risk of hospitalization and mortality. Understanding the impact of these episodes is essential to improving prevention strategies and developing more effective interventions for patients.

As per the KOLs from the UK, previous severe respiratory infections, allergic bronchopulmonary aspergillosis, impaired ciliary clearance, primary or secondary immunodeficiency, and other illnesses linked with bronchiectasis, such as COPD and severe asthma, are only a few of the predisposing factors that may be found. Despite following the suggestions in the guidelines, 40% of patients cannot determine the cause of their bronchiectasis, and only 13% of those cases result in a change in how the patients are managed.

As per the KOLs from Japan, surgery is most effective for symptomatic bronchiectasis, caused by a localized structural alteration in the airway in otherwise healthy people. The most common causes of airway damage include childhood infections such as TB, measles, pertussis, and post-infectious bronchiectasis.

Qualitative Analysis

We perform Qualitative and market Intelligence analysis using various approaches, such as SWOT and Conjoint Analysis. In the SWOT analysis, strengths, weaknesses, opportunities, and threats in terms of disease diagnosis, patient awareness, patient burden, competitive landscape, cost-effectiveness, and geographical accessibility of therapies are provided. These pointers are based on the Analyst's discretion and assessment of the patient burden, cost analysis, and existing and evolving treatment landscape.

Conjoint Analysis analyzes multiple emerging therapies based on relevant attributes such as safety, efficacy, frequency of administration, route of administration, and order of entry. Scoring is given based on these parameters to analyze the effectiveness of therapy.

To analyze the effectiveness of these therapies, have calculated their attributed analysis by giving them scores based on their ability to improve atrial and ventricular dimension/function and ability to regulate heart rate.

Further, the therapies' safety is evaluated wherein the adverse events are majorly observed, and it sets a clear understanding of the side effects posed by the drug in the trials, which directly affects the safety of the molecule in the upcoming trials. It sets a clear understanding of the side effects posed by the drug in the trials. In addition, the scoring is also based on the route of administration, order of entry and designation, probability of success, and the addressable patient pool for each therapy. According to these parameters, the final weightage score and the ranking of the emerging therapies are decided.

Market Access and Reimbursement

DelveInsight's 'Bronchiectasis - Market Insights, Epidemiology, and Market Forecast - 2034' report provides a descriptive overview of the market access and reimbursement scenario of bronchiectasis.

This section includes a detailed analysis of the country-wise healthcare system for each therapy, enlightening the market access, reimbursement policies, and health technology assessments.

The report provides detailed insights on the country-wise accessibility and reimbursement scenarios, cost-effectiveness scenarios, programs making accessibility easier and out-of-pocket costs more affordable, insights on patients insured under federal or state government prescription drug programs, etc.

Scope of the Report:

• The report covers a segment of key events, an executive summary, and a descriptive overview of bronchiectasis explaining its causes, signs and symptoms, pathogenesis, and currently available therapies.
• Comprehensive insight into the epidemiology segments and forecasts, the future growth potential of diagnosis rate, disease progression, and treatment guidelines have been provided.
• Additionally, an all-inclusive account of the current and emerging therapies and the elaborative profiles of late-stage and prominent therapies will impact the current treatment landscape.
• A detailed review of the bronchiectasis market, historical and forecasted market size, market share by therapies, detailed assumptions, and rationale behind our approach is included in the report, covering the 7MM drug outreach.
• The report provides an edge while developing business strategies by understanding trends through SWOT analysis and expert insights/KOL views, patient journey, and treatment preferences that help shape and drive the 7MM bronchiectasis market.

Bronchiectasis report insights

• Patient Population
• Therapeutic Approaches
• bronchiectasis Pipeline Analysis
• bronchiectasis Market Size and Trends
• Existing and Future Market Opportunity

Bronchiectasis report key strengths

• 11 years Forecast
• The 7MM Coverage
• bronchiectasis Epidemiology Segmentation
• Key Cross Competition
• Attribute analysis
• Drugs Uptake and Key Market Forecast Assumptions

Bronchiectasis report assessment

• Current Treatment Practices
• Unmet Needs
• Pipeline Product Profiles
• Market Attractiveness
• Qualitative Analysis (SWOT and Attribute Analysis)

Key Questions:

Market Insights

• What was the total market size of bronchiectasis, the market size of bronchiectasis by therapies, and market share (%) distribution in 2020, and what would it look like by 2034? What are the contributing factors for this growth?
• How will Brensocatib affect the treatment paradigm of bronchiectasis?
• Which drug is going to be the largest contributor by 2034?
• What are the pricing variations among different geographies for approved and marketed therapies?
• How would future opportunities affect the market dynamics and subsequent analysis of the associated trends?

Epidemiology Insights

• What are the disease risks, burdens, and unmet needs of bronchiectasis? What will be the growth opportunities across the 7MM with respect to the patient population pertaining to bronchiectasis?
• What is the historical and forecasted bronchiectasis patient pool in the United States, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan?
• Out of the countries mentioned above, which country would have the highest diagnosed prevalent bronchiectasis population during the forecast period (2024-2034)?
• What factors are contributing to the growth of bronchiectasis cases?

Current Treatment Scenario, Marketed Drugs, and Emerging Therapies

• What are the current options for the treatment of bronchiectasis? What are the current clinical and treatment guidelines for treating bronchiectasis?
• How many companies are developing therapies for the treatment of bronchiectasis?
• How many emerging therapies are in the mid-stage and late stage of development for treating bronchiectasis?
• What are the recent novel therapies, targets, mechanisms of action, and technologies developed to overcome the limitations of existing therapies?
• What is the cost burden of current treatment on the patient?
• Patient acceptability in terms of preferred treatment options as per real-world scenarios?
• What are the accessibility issues of approved therapy in the US?
• What is the 7MM historical and forecasted market of bronchiectasis?

Reasons to Buy:

• The report will help develop business strategies by understanding the latest trends and changing treatment dynamics driving the bronchiectasis market.
• Insights on patient burden/disease prevalence, evolution in diagnosis, and factors contributing to the change in the epidemiology of the disease during the forecast years.
• Understand the existing market opportunities in varying geographies and the growth potential over the coming years.
• The distribution of historical and current patient share is based on real-world prescription data in the US, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan.
• Identifying upcoming solid players in the market will help devise strategies to help get ahead of competitors.
• Detailed analysis and ranking of class-wise potential current and emerging therapies under the conjoint analysis section to provide visibility around leading classes.
• Highlights of Access and Reimbursement policies for bronchiectasis, barriers to accessibility of approved therapy, and patient assistance programs.
• To understand Key Opinion Leaders' perspectives around the accessibility, acceptability, and compliance-related challenges of existing treatment to overcome barriers in the future.
• Detailed insights on the unmet needs of the existing market so that the upcoming players can strengthen their development and launch strategy.