A chronic cough lasting months, daily thick mucus production, and repeated lung infections are frequently overlooked as normal signs of aging or past smoking. Yet for roughly 1 in 100 Medicare beneficiaries, these symptoms may indicate bronchiectasis, a progressive lung disease that often results in hospitalization. Recent research examining Medicare claims from 2016 to 2023 sheds light on the condition’s unrecognized impact among older adults.
In 2023, Medicare records identified 535,038 enrollees with non-cystic fibrosis bronchiectasis, translating to about 1,004 cases per 100,000 person-years. The condition’s prevalence increased steadily with age and remained consistently higher in women across all demographic groups. While regional variations appeared, the study did not provide detailed geographic breakdowns.
A separate analysis followed 600,841 newly diagnosed patients between 2017 and 2022, tracking them for an average of nearly three years. Their average age stood at 76, with 61% being women. Among those in traditional Medicare plans, 66.2% experienced at least one hospitalization, and 78.5% required emergency department visits. Average spending for patients in traditional Medicare reached $8,998 per person per month in 2023 dollars, combining medical and pharmacy costs, with inpatient hospital care accounting for $4,968 of that.
How Bronchiectasis Worsens Over Time
This data reveals how bronchiectasis, often dismissed in older adults, drives extensive healthcare utilization. Unlike acute illnesses, it progresses as a recurring cycle of airway damage, mucus accumulation, and infections. The National Heart, Lung, and Blood Institute explains that trapped mucus creates an environment where bacteria thrive, progressively worsening lung function. Common symptoms include a persistent cough lasting at least eight weeks, daily mucus production, breathlessness, and fatigue. In severe cases, patients may cough up blood, necessitating urgent medical attention.
Diagnosis typically requires a chest CT scan, though billing codes in Medicare records may have missed some cases or included incorrect classifications. The study’s authors noted these figures reflect only those already diagnosed, not the broader population with chronic coughs—most of which stem from asthma, COPD, or acid reflux.
Until recently, treatment focused on managing symptoms through airway clearance techniques, exercise, and infection control. In August 2025, the FDA approved brensocatib (Brinsupri), the first drug specifically targeting non-cystic fibrosis bronchiectasis in patients aged 12 and older. Clinical trials demonstrated it reduced annual flare-ups by 19% to 21% compared to placebo, though its annual list price of $88,000 raises concerns about accessibility. Coverage under Medicare Part D remains unclear, and potential side effects, including skin reactions and dental problems, must be carefully considered.
New Drug Offers Hope, With Cost Concerns
For older adults with persistent respiratory symptoms, early detection could alter the disease’s progression. The Medicare data indicate bronchiectasis is more common than previously recognized, yet its consequences are often underestimated.
Researchers will present these findings at the CHEST 2026 Annual Meeting in Phoenix, where they will stress the need for greater awareness among primary care physicians. Many older patients with bronchiectasis report visiting multiple doctors before receiving a diagnosis, often after symptoms like chronic cough or recurrent infections are attributed to other conditions. The presentation will highlight how recognizing patterns, such as persistent mucus production, frequent antibiotic use, or a history of lung infections, could prompt earlier chest CT scans, the standard diagnostic tool.
Diagnostic challenges persist due to reliance on billing codes, which may undercount cases or include misclassifications. The Medicare data do not distinguish between bronchiectasis caused by prior infections, structural lung diseases, or unknown factors. However, the National Heart, Lung, and Blood Institute identifies infections, particularly those caused by bacteria like Pseudomonas aeruginosa, as a leading trigger. Sputum cultures and blood tests can pinpoint these pathogens, guiding targeted antibiotic therapy, though overuse of broad-spectrum antibiotics may contribute to resistance.
