Heat olive oil in a large skillet over medium-high heat. Add sliced sausage and cook until browned. Remove and set aside.
In the same skillet, add onion and cook until softened, about 3 minutes. Stir in garlic and cook 30 seconds until fragrant.
Add uncooked pasta and chicken broth. Bring to a gentle boil, then reduce heat and simmer, stirring occasionally, until pasta is tender and liquid is mostly absorbed.
Stir in honey BBQ sauce and crushed red pepper flakes.
Return sausage to the skillet and simmer until sauce thickens and coats the pasta.
Stir in cream or cheese if using.
Taste, adjust seasoning, garnish, and serve hot.