Nutritional management in bronchiectasis: A practical guide for clinicians

Bronchiectasis is a chronic and heterogeneous pulmonary disease characterized by permanent airway dilatation resulting from a complex and interconnected cycle of impaired mucociliary clearance, persistent airway inflammation, and recurrent infection, with this 'vicious vortex', ultimately leading to progressive lung damage and reduced quality of life over time. Malnutrition is common and represents a major prognostic factor in bronchiectasis, associated with impaired lung function, increased hospitalization, and higher mortality. Systematic nutritional assessment and intervention should therefore be integrated into routine care for these patients. However, evidence guiding optimal nutritional strategies remains limited, and validated nutritional guidelines for bronchiectasis are lacking. This review provides a structured framework to support clinicians in optimizing nutritional management in bronchiectasis, based on the treatable traits model proposed by Boaventura et al. in 2018. We examine the pathophysiology of malnutrition across the four domains of treatable traits, including aetiological, pulmonary, extrapulmonary, and environmental factors, to elucidate the complex bidirectional relationship between malnutrition and bronchiectasis. Finally, we highlight the treatable traits framework as a foundation for the development of a practical nutritional checklist and clinical toolbox. Through this pragmatic approach, clinicians may deliver personalized and precise nutritional assessment and management, with the potential to improve clinical outcomes and prognosis in bronchiectasis.