Treatable traits in paediatric bronchiectasis: current practice and a proposed checklist

We recently published a treatable traits (TT) framework for children with non-cystic fibrosis bronchiectasis (NCFB). Whether these traits are routinely documented as assessed and identified in clinical practice is unknown. We conducted a retrospective study of children (< 18 years) with CT-confirmed NCFB followed at a tertiary referral centre (2010-2024). For each patient, we determined which of 41 predefined TTs across four domains-aetiological (n = 6), pulmonary (n = 15), extrapulmonary (n = 9), and behavioural/environmental (n = 11)-were documented as assessed, and among those assessed, which were identified. Among 121 children (median age 10.1 years; median 2 exacerbations/year), only 20 out of 41 TTs (49%) were documented as assessed per patient, and a median of 6 were identified. Aetiological and pulmonary traits were more frequently documented as assessed than extrapulmonary and behavioural. Anxiety and depression in children or parents, as well as viral prevention measures, were never documented, and treatment adherence was rarely recorded. When traits were documented as assessed, several were frequently identified: neutrophilic inflammation was found in 93%, eosinophilic inflammation in 35%, and short-acting beta-agonist overuse in 47% of assessed patients.

Even in a tertiary referral centre, half of TTs lacked documented assessment in children with NCFB, particularly psychosocial and behavioural factors. Based on these findings, we propose a pragmatic TT checklist, used as a flexible clinical guide, to support structured, clinically relevant, and traceable assessment of children with NCFB in routine care.

• Paediatric non-cystic fibrosis bronchiectasis is a heterogeneous disease requiring individualised management. • A "treatable traits" approach has been proposed to guide precision medicine beyond standard guidelines.

• In real-life paediatric practice, only half of treatable traits are documented as assessed, with psychosocial and behavioural factors particularly infrequently documented. • We propose a pragmatic checklist to support structured, clinically guided assessment and improve routine care.