| Abstract Bronchiectasis is a common chronic inflammatory airway disease in China, with a rising prevalence and a substantial disease and socioeconomic burden. With an improved understanding of the pathogenesis and inflammatory mechanisms of bronchiectasis, treatment paradigms have increasingly shifted from conventional empirical management toward a precision-based approach centered on treatable traits. In recent years, the evidence base supporting anti-infective strategies, including long-term macrolide therapy, inhaled antibiotics, and pathogen-directed diagnostic testing, has continued to expand. Notably, the development of targeted anti-inflammatory therapies, particularly dipeptidyl peptidase-1 (DPP-1) inhibitors, represents a major therapeutic advance and provides a new treatment option for patients with neutrophil-dominant inflammation. Non-pharmacological interventions, including airway clearance techniques and pulmonary rehabilitation, have also demonstrated important benefits in improving symptoms, reducing exacerbations, and enhancing quality of life. The 2025 European Respiratory Society (ERS) and 2026 American College of Chest Physicians (CHEST) guidelines further emphasize individualized, comprehensive management based on disease etiology, inflammatory phenotype, chronic infection status, and risk of exacerbations. This review summarizes the latest evidence from international and Chinese studies and guidelines published between 2021 and 2026, focusing on anti-infective and anti-inflammatory therapies, non-pharmacological interventions, and emerging approaches in precision medicine for adults with bronchiectasis. Current research priorities and future directions are also discussed, with the aim of informing the standardized and precision-based management of adult bronchiectasis in China. |
