Rehabilitation interventions in bronchiectasis: expanding evidence, personalization, and clinical practice

Abstract

Bronchiectasis is a chronic and heterogeneous respiratory disease characterized by irreversible airway dilation, recurrent infection, persistent inflammation, and progressive functional impairment. Pulmonary rehabilitation is consistently recommended in international guidelines as a core non-pharmacological intervention; however, its implementation in clinical practice remains inconsistent and access to comprehensive rehabilitation programmes remains limited despite strong guideline endorsement. Recent advances in disease conceptualization, particularly the treatable traits framework, together with growing evidence supporting exercise training, physical activity promotion, and digitally enabled care models, have expanded the scope and relevance of rehabilitation in bronchiectasis. This Mini Review synthesizes contemporary evidence on rehabilitation interventions, integrating established practices with emerging strategies, and critically discusses current controversies, research gaps, and future directions. While airway clearance and exercise training remain foundational, current European Respiratory Society guidance supports their use based on defined patient profiles and evidence strength, and increasing evidence supports individualized, multimodal rehabilitation approaches that incorporate physical activity promotion, adjunct interventions, home-based and tele-rehabilitation models, and patient-managed strategies. Persistent uncertainties regarding optimal prescription, implementation, and long-term outcomes underscore the need for patient-centered, phenotype-informed rehabilitation strategies. Broadening rehabilitation beyond traditional paradigms may enhance clinical relevance, improve functional outcomes, and better align care with the complex and evolving nature of bronchiectasis.