Treatable traits-based management of bronchiectasis: moving from theory to clinical practice.

Bronchiectasis is a chronic airway disease characterized by irreversible bronchial dilatation and substantial clinical heterogeneity. Accumulating evidence from large international observational cohorts has highlighted wide variation in the features of this disease and unmet clinical needs. The treatable traits-based approach has emerged as a means to prioritize identifiable and clinically actionable problems over traditional diagnostic labels. In this review, we summarize the reported prevalence of major treatable traits across large cohorts and describe notable regional differences, alongside the ongoing absence of data relating to behavioral and environmental traits. We further update the treatable traits framework based on recent guideline recommendations, clarifying the strength of evidence supporting the interventions available. We also review selected molecular mechanisms relevant to key treatable traits. Despite growing interest, the use of treatable traits in routine practice is restricted by ambiguous terminology, insufficient prospective data, and inadequate evidence for many therapies. However, the fundamental constraint for implementation is not insufficient characteristic identification, but rather the attempt to manage a complicated and non-linear disease system with a static checklist. Future research should emphasize standardized definitions and real-world longitudinal studies, and develop practical tools to help clinicians determine which traits should be addressed first. Such efforts may support transparent, individualized, and adaptive decision-making in bronchiectasis.