Bronchiectasis: Past insights, present clinical evidence, and future research pathways

Bronchiectasis is a chronic disease characterized by irreversible airway dilation, persistent inflammation, and recurrent infections. Its global prevalence has risen significantly, now surpassing 1400 cases per 100,000 in certain regions, likely due to increased awareness over the last several decades. Bronchiectasis exhibits wide heterogeneity in etiology and clinical phenotype. Advances in imaging, microbiology, and biomarker profiling have refined diagnostic accuracy and revealed distinct endotypes, including those characterized by neutrophilic and eosinophilic inflammation. Innovations in therapy, ranging from airway clearance and inhaled antibiotics to emerging biologics and neutrophil-targeted therapies, underscore a shift toward individualized treatment. In this review, we provide a comprehensive and up-to-date discussion of the pathophysiological mechanisms, etiologies, and evolving management strategies in bronchiectasis.