Nonpharmacologic Care of Bronchiectasis: Addressing Frailty with Nutrition and Physical Activity

Bronchiectasis is a chronic airway disease marked by recurrent infections, progressive inflammation, and declining pulmonary function. While pharmacologic therapies remain central to management, nonpharmacologic strategies-particularly nutrition and physical activity-are underutilized, despite growing evidence.

This review examines the role of nutritional support and physical activity in managing bronchiectasis, highlighting their impact on frailty, systemic inflammation, and functional outcomes.

Frailty is increasingly recognized in bronchiectasis, particularly in patients with comorbid nontuberculous mycobacterial lung disease (NTM-LD), where prevalence may exceed 40%. Malnutrition, low body mass index (BMI), and sarcopenia are associated with poorer lung function, increased hospitalizations, and mortality. Meanwhile, physical inactivity-measured by low step count and prolonged sedentary time-is a strong predictor of exacerbation risk and healthcare utilization. Evidence supports the use of high-calorie, protein-rich diets and resistance-based exercise training to improve muscle mass, immune function, and quality of life. Synergistic effects are observed when nutritional interventions are combined with pulmonary rehabilitation. However, barriers to implementation remain, including a lack of access, under-referral, and limited emphasis on guidelines.

Nutritional and physical activity interventions offer measurable clinical benefits in bronchiectasis and should be integrated into routine multidisciplinary care. Future research should prioritize the validation of frailty screening tools, the implementation of effective strategies, and the development of policy mechanisms to expand coverage for dietetic and rehabilitation services.