Bronchiectasis management in adults: state of the art and future directions Bronchiectasis, once considered a rare condition, is now increasingly recognized. Recent research has led to significant progress in understanding and managing this disease. Randomized clinical trials have shown the benefits of airway clearance techniques, inhaled antibiotics, and long-term macrolide therapy in patients with bronchiectasis. However, the heterogeneity of bronchiectasis remains a major challenge in its management. The identification of phenotypes and endotypes has helped in finding "treatable traits" and partially overcome the complexity of the disease. The goals of treatment are to reduce symptoms, improve quality of life, reduce exacerbations, and prevent disease progression. This review discusses pharmacological and non-pharmacological treatments that improve mucociliary clearance, reduce airway inflammation, and address airway infection, which are key pathophysiological features of bronchiectasis. Promising new treatments, including novel anti-inflammatory therapies, are also in development. This review provides a critical update on the management of bronchiectasis, focusing on treatable traits and recent randomized clinical trials. The authors are Hayoung Choi, Pamela J. McShane, Stefano Aliberti, and James D. Chalmers. The article was published in the European Respiratory Journal in 2024.Bronchiectasis management in adults: state of the art and future directions Bronchiectasis, once considered a rare condition, is now increasingly recognized. Recent research has led to significant progress in understanding and managing this disease. Randomized clinical trials have shown the benefits of airway clearance techniques, inhaled antibiotics, and long-term macrolide therapy in patients with bronchiectasis. However, the heterogeneity of bronchiectasis remains a major challenge in its management. The identification of phenotypes and endotypes has helped in finding "treatable traits" and partially overcome the complexity of the disease. The goals of treatment are to reduce symptoms, improve quality of life, reduce exacerbations, and prevent disease progression. This review discusses pharmacological and non-pharmacological treatments that improve mucociliary clearance, reduce airway inflammation, and address airway infection, which are key pathophysiological features of bronchiectasis. Promising new treatments, including novel anti-inflammatory therapies, are also in development. This review provides a critical update on the management of bronchiectasis, focusing on treatable traits and recent randomized clinical trials. The authors are Hayoung Choi, Pamela J. McShane, Stefano Aliberti, and James D. Chalmers. The article was published in the European Respiratory Journal in 2024.