Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jun 30;17(6):4302-4322.
doi: 10.21037/jtd-2024-2106. Epub 2025 Jun 18.

Addressing treatable traits in bronchiectasis through non-pharmacological therapies: a narrative review

Annemarie L Lee  1   2 , Arietta Spinou  3 , Ashwin Basavaraj  4
Affiliations
Review

Addressing treatable traits in bronchiectasis through non-pharmacological therapies: a narrative review

Annemarie L Lee et al. J Thorac Dis. .

Abstract

Background and objective: Treatable traits in bronchiectasis have been classified as pulmonary, etiological, extra-pulmonary and behavioral or lifestyle factors. A range of non-pharmacological interventions may be applied to address these traits, with selected therapies applicable to multiple traits. The aim of this narrative review was to synthesize the evidence for non-pharmacological therapies through the lens of treatable traits for adults with bronchiectasis and highlight the clinical effects of these treatments.

Methods: Electronic searches of PubMed and Medline using specific keywords were conducted. Articles underwent screening for relevance, with potential sources from review articles, systematic and scoping reviews, case series, prospective and retrospective studies, clinical practice guidelines and statements, and editorials in peer-reviewed journals. The data included were limited to English publications from 1980 to 2024.

Key content and findings: Of those traits which fall under the pulmonary and etiology categories, treatment options include airway clearance therapy, adjuncts to airway clearance such as mucoactive agents, smoking cessation programs, non-invasive ventilation and oxygen therapy, including high flow nasal therapy. Extra-pulmonary traits that are amenable to non-pharmacological approaches included psychological symptoms, nutritional concerns, gastroesophageal reflux disease, rhinosinusitis and cardiovascular disease. Treatment options span from cognitive behavioral therapy and counselling, nutritional advice and supplements, lifestyle adjustments and nasal-sinus irrigation. Key behavioral or lifestyle traits are low treatment adherence, smoking and lack of exercise. These are addressed via education and self-management programs, smoking cessation, pulmonary rehabilitation and other forms of exercise or physical activity.

Conclusions: A variety of non-pharmacological therapies may be applied to address treatable traits in those with bronchiectasis and adopting an integrated approach is important to optimize patient outcomes. Further studies could guide the implementation of non-pharmacological interventions for newly identified treatable traits in this population.

Keywords: Bronchiectasis; adherence; comorbidities; physiotherapy; treatable traits.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2024-2106/coif). The series “Frontiers in Bronchiectasis Management: Translational Science and Practice” was commissioned by the editorial office without any funding or sponsorship. A.S. serves as a member of the Infections Special Advisory Group for the British Thoracic Society, a member of EMBARC3 and was the Chair of the European Respiratory Society Statement in airway clearance for bronchiectasis. A.B. declares consulting fees from INSMED and BAXTER, support for meeting travel from INSMED, payment for CME educational event for TACTILE, and is the principal investigator for a clinical trial for BAXTER and MANNKIND (funding distributed to institution). The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Treatable traits amenable to non-pharmacological therapies, based on the original proposal of traits by Boaventura et al. (2018).
Figure 2
Figure 2
Airway clearance therapy options. ACBT, active cycle of breathing technique; ELTGOL, total slow expiration with glottis opened in lateral posture; FET, forced expiratory technique; HFCWO, high frequency chest wall oscillation; IPV, intrapulmonary percussive ventilation; OPEP, oscillating positive expiratory pressure; PEP, positive expiratory pressure; T-PEP, temporary positive expiratory pressure.
Figure 3
Figure 3
Strategies to facilitate self-management.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Chang AB, Bell SC, Byrnes CA, et al. Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand. Respirology 2023;28:339-49. 10.1111/resp.14479 - DOI - PMC - PubMed
    1. Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017;50:1700629. 10.1183/13993003.00629-2017 - DOI - PubMed
    1. Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society Guideline for bronchiectasis in adults. Thorax 2019;74:1-69. 10.1136/thoraxjnl-2018-212463 - DOI - PubMed
    1. Herrero-Cortina B, Lee AL, Oliveira A, et al. European Respiratory Society statement on airway clearance techniques in adults with bronchiectasis. Eur Respir J 2023;62:2202053. 10.1183/13993003.02053-2022 - DOI - PubMed
    1. Chotirmall SH, Chalmers JD. The Precision Medicine Era of Bronchiectasis. Am J Respir Crit Care Med 2024;210:24-34. 10.1164/rccm.202403-0473PP - DOI - PMC - PubMed

LinkOut - more resources