Bronchiectasis is a chronic disease marked by productive cough, recurrent infections, and airway inflammation, resulting in progressive airway dilation and increased morbidity and mortality. Current treatment strategies focus on reducing frequency of flares, slowing disease progression, and improving quality of life through airway clearance and pharmacologic intervention. Emerging research reveals two powerful yet underutilized tools in managing bronchiectasis: nutrition and exercise.1
The role of nutrition in bronchiectasis
Malnutrition and micronutrient deficiencies have been increasingly recognized as modifiable risk factors influencing disease severity. A study assessing biomarkers of disease severity found that lower BMI was associated with poorer lung function, though it was not directly correlated with exacerbation frequency.2 The BACES score found a BMI of less than 18.5 as a key predictor of mortality in nontuberculous mycobacterial disease.3 Low visceral fat area and reduced nutrient intake were observed in patients with Mycobacterium avium complex lung disease, suggesting that poor nutritional status may accelerate disease progression.4
Additionally, research shows that patients with bronchiectasis with vitamin D deficiency experience more severe disease, poorer lung function, and increased exacerbation rates. Supplementation may be a strategy to enhance immune response and improve respiratory health.5
The role of exercise training and physical activity in bronchiectasis
Endurance and strength training is associated with improved peripheral muscle strength, aerobic capacity, and symptom burden in other chronic respiratory diseases such as COPD.1 In bronchiectasis, daily physical activity has been shown to reduce rates of hospitalization. Patients who walked less than 6,290 steps per day or had increased sedentary behavior more than 7.8 hours per day were 5.91 times more likely to have a hospital admission due to bronchiectasis exacerbation at one-year follow-up. Notably, this risk was adjusted for relevant confounders, including age, gender, chronic Pseudomonas aeruginosa colonization, and hospitalizations within the 12 months prior to study enrollment.6
Moreover, a recent Cochrane Review showed that patients with stable bronchiectasis who completed exercise training had improved functional exercise tolerance with an average 42 m increase in six-minute walk distance and 87 m increase in incremental shuttle walk distance. These patients also had clinically significant improvements in St. George’s Respiratory Questionnaire scores. Unfortunately, there was no change in cough-related quality of life, as measured by Leicester Cough Questionnaire scores, or impact on anxiety or depression. Long-term adherence remains a challenge, necessitating ongoing supervision, home-based programs, and digital health solutions.7
Future directions and policy implications
Despite increasing evidence, nutritional guidance and pulmonary rehabilitation are not yet standard components of bronchiectasis care. Expanding insurance coverage to allow for integration of pulmonary rehabilitation, structured exercise programs, nutritional counseling, and frailty assessments into bronchiectasis care is a necessity for improving long-term patient outcomes.8 As bronchiectasis treatment continues to evolve, a multidisciplinary, patient-centered approach will be critical to optimizing outcomes and enhancing quality of life.
References
1. Derbyshire EJ, Calder PC. Bronchiectasis—could immunonutrition have a role to play in future management? Front Nutr. 2021;8:652410. doi: 10.3389/fnut.2021.652410
2. Despotes KA, Choate R, Addrizzo-Harris D, et al. Nutrition and markers of disease severity in patients with bronchiectasis. Chronic Obstr Pulm Dis. 2020;7(4):390-403. doi: 10.15326/jcopdf.7.4.2020.0178
3. Kim HJ, Kwak N, Hong H, et al. BACES score for predicting mortality in nontuberculous mycobacterial pulmonary disease. Am J Respir Crit Care Med. 2021;203(2):230-236. doi: 10.1164/rccm.202004-1418OC.
4. Wakamatsu K, Nagata N, Maki S, et al. Patients with MAC lung disease have a low visceral fat area and low nutrient intake. Pulm Med. 2015;2015:1-5. doi: 10.1155/2015/218253
5. Ferri S, Crimi C, Heffler E, Campisi R, Noto A, Crimi N. Vitamin D and disease severity in bronchiectasis. Respir Med. 2019;148:1-5. doi: 10.1016/j.rmed.2019.01.009
6. Lee AL, Gordon CS, Osadnik CR. Exercise training for bronchiectasis. Cochrane Database Syst Rev. 2021;4(4):CD013110. doi: 10.1002/14651858.CD013110.pub2
7. Alcaraz-Serrano V, Gimeno-Santos E, Scioscia G, et al. Association between physical activity and risk of hospitalisation in bronchiectasis. Eur Respir J. 2020;55(6):1902138. doi: 10.1183/13993003.02138-2019
8. Lan CC, Lai SR, Chien JY. Nonpharmacological treatment for patients with nontuberculous mycobacterial lung disease. J Formos Med Assoc. 2020;119:S42-S50. doi: 10.1016/j.jfma.2020.05.013