Lifestyle Medicine and Bronchiectasis in Viet Nam: Airway Clearance, Pulmonary Rehabilitation, and Exacerbation Management

Lifestyle Medicine and Bronchiectasis in Viet Nam: Airway Clearance, Pulmonary Rehabilitation, and Exacerbation Management

Last reviewed: October 31, 2026

A person living with bronchiectasis may become accustomed to coughing up sputum every morning. On some days, clearing the chest takes only a few minutes. On others, the coughing continues, breathing becomes more difficult, and ordinary activities feel exhausting. Another person may produce relatively little sputum but experience repeated respiratory infections that interrupt work, family life, and sleep.

These experiences reflect an important characteristic of bronchiectasis: patients with the same diagnosis can have very different symptoms, underlying causes, and treatment needs.

Some struggle primarily with retained airway secretions. Others experience breathlessness, declining exercise capacity, frequent exacerbations, or complications related to chronic infection. The condition may also coexist with asthma, chronic obstructive pulmonary disease, immunodeficiency, or other medical problems that influence treatment.

General advice to exercise regularly, drink enough water, and maintain a healthy diet may support overall health, but it cannot address every clinical problem associated with bronchiectasis.

Airway clearance techniques can help patients manage retained secretions, while pulmonary rehabilitation can improve physical capacity in appropriately selected individuals. However, these are specialized clinical interventions rather than ordinary breathing or fitness exercises. Their benefits depend on suitable assessment, professional instruction, and ongoing evaluation.

For healthcare professionals in Viet Nam, evidence-based Lifestyle Medicine offers an opportunity to support physical activity, nutritional health, avoidance of harmful exposures, and sustainable self-management while ensuring that respiratory treatment, microbiological assessment, and timely management of exacerbations remain central to care.

Understanding Bronchiectasis and Its Underlying Causes

Bronchiectasis is a chronic respiratory condition characterized by abnormal and persistent dilation of the bronchi, commonly associated with impaired mucus clearance, airway inflammation, and recurrent respiratory infections.

These processes can reinforce one another. Retained secretions may favor bacterial persistence, while infection and inflammation can contribute to further airway injury and impaired mucus clearance.

The clinical presentation varies considerably. Some people produce substantial amounts of sputum every day. Others experience persistent cough, breathlessness, fatigue, intermittent hemoptysis, or recurrent exacerbations. Some may have relatively limited symptoms despite structural abnormalities identified on chest imaging.

The diagnosis of clinically significant bronchiectasis requires consideration of the clinical presentation together with characteristic findings on appropriate chest computed tomography.

Chronic cough or sputum production alone does not establish the diagnosis. Similarly, bronchial dilation identified on imaging does not necessarily mean that every patient has the same severity of disease or requires identical treatment.

Thin-section chest computed tomography can identify bronchial dilation, mucus plugging, and associated structural changes. These findings need to be interpreted alongside symptoms, medical history, pulmonary function, and other relevant investigations.

The European Respiratory Society's updated 2025 guideline emphasizes identifying underlying causes and potentially treatable factors rather than focusing exclusively on cough or sputum production.

Depending on clinical circumstances, assessment may include sputum microbiology, pulmonary function testing, blood counts, immunoglobulin measurements, and investigation for allergic bronchopulmonary aspergillosis or nontuberculous mycobacterial infection.

Further evaluation may be appropriate when the history suggests immunodeficiency, autoimmune disease, recurrent aspiration, or an inherited respiratory disorder.

Identifying the underlying cause matters because treatment can differ substantially. A patient with immunodeficiency may require specialist immunological assessment. Someone with allergic bronchopulmonary aspergillosis may need disease-specific treatment, while a person with nontuberculous mycobacterial disease may require a prolonged and carefully selected antimicrobial regimen.

Lifestyle interventions can support general health and daily functioning, but they cannot replace these investigations or treatments.

This article focuses on adults with non-cystic fibrosis bronchiectasis. Its discussion should not be applied automatically to children or people with cystic fibrosis, whose management requires additional disease-specific considerations.

What the 2025 and 2026 International Guidelines Mean for Care

Two major international guidelines now provide an updated evidence base for adult bronchiectasis management.

The European Respiratory Society published its revised clinical practice guideline in 2025. The American College of Chest Physicians subsequently published its guideline on adult bronchiectasis online on July 21, 2026, with the final article appearing in the October 2026 issue of CHEST.

Both emphasize individualized treatment, although their recommendations differ in scope, strength, and the certainty of supporting evidence.

The European guideline strongly recommends that patients with bronchiectasis be taught airway clearance techniques. It also strongly recommends offering pulmonary rehabilitation to patients who experience breathlessness or impaired exercise capacity.

The certainty of evidence supporting these recommendations was rated as very low.

This distinction matters because the strength of a clinical recommendation does not necessarily correspond directly to the certainty of evidence from clinical trials. Guideline panels also consider expected benefits, potential harms, patient preferences, feasibility, treatment burden, and the consequences of not offering an intervention.

The 2026 CHEST guideline reviewed 47 studies and developed 13 evidence-based recommendations addressing antimicrobial treatment, airway clearance, selected anti-inflammatory therapies, hemoptysis, and surgical management.

Its recommendations are conditional, but the certainty of supporting evidence differs between interventions.

Evidence supporting long-term macrolide therapy and brensocatib in selected patients with frequent exacerbations was rated as moderate certainty. Evidence for several airway clearance methods and other interventions remained low or very low certainty.

The guidelines should therefore not be interpreted as directly contradictory simply because their recommendations have different strengths. They address somewhat different clinical questions and apply structured methods to evaluate the available evidence.

Taken together, they emphasize the importance of selecting interventions according to symptoms, underlying disease, microbiological findings, functional limitations, and future exacerbation risk.

The practical implication is that bronchiectasis care should not follow an identical treatment package for everyone. Management needs to address the clinical problems that matter most to each patient.

Airway Clearance Must Be Matched to the Patient

Airway clearance techniques are an important component of bronchiectasis management because they help mobilize and remove retained airway secretions.

Several approaches are available, including the active cycle of breathing techniques, controlled breathing with forced expiratory maneuvers, positive expiratory pressure devices, oscillatory positive expiratory pressure, and selected positioning or respiratory physiotherapy methods.

Some techniques require no equipment, while others use devices to support secretion mobilization.

The 2025 European Respiratory Society guideline emphasizes that no single airway clearance technique has been shown to be consistently superior to all others.

Selection should therefore reflect the patient's symptoms, sputum production, physical capacity, tolerance, comorbidities, and preferences.

An important feature of the updated guidance is that airway clearance instruction is no longer limited to patients with chronic productive cough.

Some people who produce relatively little sputum may still have mucus plugging identified on imaging or difficulty mobilizing secretions. These patients may benefit from assessment and appropriate instruction.

However, this does not mean that everyone requires the same frequency, intensity, or duration of treatment.

Someone producing substantial amounts of sputum every morning may benefit from a regular airway clearance routine, while a person with relatively limited symptoms may require a different approach.

The 2026 CHEST guideline conditionally supports several techniques, including breathing-based methods, positive expiratory pressure, and high-frequency chest wall oscillation.

These recommendations do not establish that a particular commercial airway clearance device is superior or necessary for every patient.

Airway clearance is best introduced by an appropriately qualified respiratory physiotherapist, respiratory therapist, or another healthcare professional with relevant training and experience.

Instruction should be followed by assessment of whether the patient can perform the technique correctly, whether it is tolerated, and whether it improves secretion clearance or daily functioning.

Practical circumstances matter.

A person working long hours may struggle to follow a complicated routine requiring expensive equipment. Another with musculoskeletal pain, fatigue, or substantial reflux may find certain positions or techniques uncomfortable.

A treatment plan needs to consider these barriers from the beginning. A technically appropriate method may offer limited practical benefit if the patient cannot use it consistently or if the treatment burden becomes excessive.

For long-term care, the most suitable technique is not necessarily the most technologically sophisticated one. It is the approach that is clinically appropriate, safe, effective for the intended purpose, and manageable within the patient's circumstances.

Airway Clearance and Nebulized Treatment Require Safety Assessment

An airway clearance routine may need adjustment when respiratory symptoms change, particularly during an exacerbation.

However, increasing treatment intensity should not be the automatic response to every deterioration.

New hemoptysis, significant chest pain, marked breathlessness, or other concerning symptoms require appropriate clinical assessment. Forceful coughing or certain airway clearance techniques may need to be modified or temporarily withheld depending on the cause and severity of the problem.

Patients with cardiovascular instability, significant reflux, musculoskeletal limitations, or other relevant medical conditions may also require individualized techniques.

Nebulized therapies introduce further considerations.

The European guideline suggests considering mucoactive treatment when appropriate airway clearance alone has not adequately controlled symptoms. The 2026 CHEST guideline conditionally supports nebulized hypertonic saline for selected patients.

However, inhaled hypertonic saline may cause coughing, airway irritation, or bronchospasm, especially in susceptible individuals.

Its use should therefore follow suitable clinical assessment, with appropriate initiation and monitoring.

Both international guidelines recommend against routine use of recombinant human deoxyribonuclease in non-cystic fibrosis bronchiectasis.

This distinction is clinically important because a treatment used in cystic fibrosis should not automatically be assumed effective or safe for patients with another form of bronchiectasis.

Equipment hygiene also deserves attention.

Nebulizers and airway clearance devices require appropriate cleaning, maintenance, and storage according to manufacturer instructions and relevant infection-control guidance.

Poorly maintained equipment may create additional problems for someone already vulnerable to recurrent respiratory infections.

Patients also need to understand whether their device requires particular cleaning materials, replacement components, or professional maintenance.

The value of an airway clearance plan depends not only on the technique selected but also on the patient's ability to use it safely, correctly, and consistently.

Pulmonary Rehabilitation Can Improve Exercise Capacity

Breathlessness and reduced exercise tolerance are common among people with bronchiectasis.

Some patients gradually reduce their physical activity because exertion causes coughing, fatigue, or shortness of breath. Over time, inactivity may contribute to deconditioning, making everyday tasks increasingly difficult.

Pulmonary rehabilitation can help address these limitations.

A structured program generally combines individualized exercise training, education, and support for managing chronic respiratory disease.

Depending on the patient's functional capacity and clinical needs, rehabilitation may include aerobic exercise, muscle strengthening, and other suitable components.

The 2025 European Respiratory Society guideline strongly recommends offering pulmonary rehabilitation to patients with bronchiectasis who experience breathlessness or impaired exercise capacity.

This recommendation was informed by seven studies.

In three studies evaluating the six-minute walk test, pulmonary rehabilitation improved walking distance by an average of approximately 41 meters compared with usual care.

Other studies demonstrated improvements in incremental shuttle walking performance.

These findings support the role of pulmonary rehabilitation in improving exercise capacity. However, the overall certainty of evidence was rated as very low because of limitations involving sample size, study design, and other methodological factors.

The average improvement observed across studies should not be interpreted as a result every patient will achieve.

The findings also do not establish that pulmonary rehabilitation reverses structural bronchial dilation, reliably prevents all exacerbations, or reduces mortality.

Before starting rehabilitation, clinicians should assess respiratory stability, functional capacity, exercise tolerance, oxygenation when indicated, and relevant comorbidities.

Patients with significant oxygen desaturation, cardiovascular disease, severe functional limitations, or unstable respiratory symptoms may require closer monitoring or modifications to training.

The program should also consider whether coughing, sputum production, fatigue, or other symptoms affect participation.

For one patient, improvement may mean being able to walk to a nearby market without frequent rest. Another may hope to return to work, climb stairs more comfortably, or manage household activities with less breathlessness.

These improvements can be meaningful even when pulmonary function measurements change little.

Rehabilitation should therefore be evaluated through functional capacity, symptoms, safety, and quality of life rather than the number of sessions completed alone.

How Lifestyle Medicine Supports Respiratory Care

Lifestyle Medicine can contribute to bronchiectasis management by supporting behaviors that help patients maintain health and participate in treatment.

However, ordinary physical activity should be distinguished from formal pulmonary rehabilitation and specialized airway clearance.

These clinical interventions require relevant professional expertise and should not be presented as generic breathing or fitness exercises that everyone can perform without assessment.

Lifestyle Medicine can help people remain appropriately active between rehabilitation sessions, maintain adequate nutrition, avoid harmful exposures, and manage the practical demands of chronic respiratory symptoms.

Smoking cessation is particularly important for patients who use tobacco.

Avoiding secondhand smoke and reducing exposure to workplace dust, cooking fumes, and other airborne irritants may also support respiratory health.

In Viet Nam, the importance of these exposures varies according to occupation, housing, cooking arrangements, and local environmental conditions.

Some patients may benefit from changes in personal behavior, while others require workplace controls, improved ventilation, or other environmental measures.

Nutritional health is another consideration.

Chronic respiratory symptoms, recurrent illness, fatigue, and increased energy demands may contribute to poor appetite, unintentional weight loss, or reduced muscle strength.

Other patients may have overweight, obesity, diabetes, or additional cardiometabolic conditions requiring individualized nutritional care.

No particular dietary pattern or supplement has been established as a cure for bronchiectasis.

Nutritional recommendations should therefore address identified needs rather than promote restrictive diets or commercial products as alternatives to respiratory treatment.

Hydration also requires careful interpretation.

Maintaining adequate fluid intake supports general health, particularly during hot weather or illness. However, drinking progressively larger amounts of water has not been established as an effective treatment for retained airway secretions.

Patients with heart failure, kidney disease, or prescribed fluid restrictions may require individualized recommendations.

Sleep and psychological well-being deserve attention because nighttime coughing, breathlessness, fatigue, and anxiety about future exacerbations can affect rest, work, and family life.

Addressing these concerns may improve well-being and treatment participation, but persistent or worsening respiratory symptoms should not be attributed solely to stress or poor lifestyle habits.

Vaccination against relevant respiratory infections should also be reviewed according to individual indications and applicable Vietnamese recommendations.

These measures support comprehensive care. They do not replace antimicrobial treatment, investigation of underlying disease, or respiratory rehabilitation when clinically indicated.

Recognizing Exacerbations Before Serious Deterioration

Exacerbations contribute substantially to the burden of bronchiectasis because they can worsen symptoms, interrupt daily activities, increase healthcare use, and sometimes lead to hospitalization.

An exacerbation generally involves deterioration in respiratory symptoms beyond the person's usual day-to-day variation, often requiring a change in management.

Patients may experience increased cough, greater sputum production, changes in sputum consistency or purulence, worsening breathlessness, reduced exercise tolerance, fatigue, or malaise.

Hemoptysis may also occur.

The pattern of deterioration differs between patients.

Someone who routinely produces sputum every morning may recognize worsening illness through a substantial increase in volume or purulence. Another person may first notice unusual fatigue or breathlessness during activities that were previously manageable.

Understanding the patient's usual symptom pattern is therefore important.

Chronic cough does not mean that every minor fluctuation represents an exacerbation. Equally, a sudden and sustained deterioration should not be dismissed simply because respiratory symptoms have been present for years.

A review published in European Respiratory Review in June 2026 emphasized the importance of daily symptom burden in bronchiectasis.

Symptoms such as cough, sputum production, and breathlessness are increasingly recognized as meaningful expressions of disease activity and outcomes that matter directly to patients.

However, symptoms alone cannot reliably identify the responsible microorganism or determine which antimicrobial treatment is needed.

Severe exacerbations may involve respiratory distress, worsening oxygenation, hemodynamic instability, altered mental status, or other features requiring hospital-based treatment.

New hemoptysis warrants medical assessment, while substantial bleeding or associated respiratory compromise requires emergency evaluation.

Patients should receive individualized information about their usual symptoms, concerning changes, when to contact their treating team, and when emergency care is necessary.

A written action plan may help patients recognize deterioration and seek timely treatment.

However, such plans should not encourage unsupervised escalation of airway clearance or repeated antibiotic use without appropriate clinical guidance.

Microbiology Should Inform Exacerbation Treatment

Bronchiectasis management frequently requires attention to microorganisms identified in previous respiratory samples.

Some patients have repeated isolation of potentially pathogenic bacteria, including Pseudomonas aeruginosa.

Microbiological history may influence exacerbation risk, antibiotic selection, and decisions about longer-term preventive treatment.

However, isolating a microorganism during clinical stability does not automatically establish that an acute exacerbation is occurring.

Clinical symptoms and microbiological findings need to be interpreted together.

The 2025 European Respiratory Society guideline recommends obtaining a sputum sample at the onset of an exacerbation whenever feasible, ideally before antibiotic treatment begins.

The 2026 CHEST guideline conditionally recommends targeted antibiotic treatment informed by microbiological culture results.

Antibiotic selection should also consider previous cultures, antimicrobial susceptibility, illness severity, allergies, comorbidities, and earlier treatment responses.

Obtaining a sputum sample should not cause an unsafe delay when immediate treatment is clinically necessary.

Antibiotic duration also requires individualization.

The European guideline continues to describe approximately 14 days as a conventional duration, particularly for severe exacerbations or those involving Pseudomonas aeruginosa.

Shorter courses may be appropriate in selected patients with milder disease and a favorable clinical response.

The 2026 CHEST guideline allows shorter or longer courses according to clinical response while acknowledging limitations in the available evidence.

These recommendations do not establish one fixed antibiotic duration for every patient.

A person who fails to improve or becomes more unwell despite treatment requires reassessment. Some patients may need different antimicrobial treatment, intravenous antibiotics, or hospitalization.

Appropriate airway clearance and supportive measures may remain useful during an exacerbation, but they cannot replace clinically indicated treatment of a significant respiratory infection.

For selected patients with recurrent exacerbations, an individualized written action plan may include clinician-authorized rescue medication.

Such arrangements require prior assessment, clear instructions, and appropriate follow-up. They should not be confused with self-directed antibiotic use or repeated treatment without professional oversight.

Preventing Recurrent Exacerbations Requires Individualized Treatment

Some patients continue to experience frequent exacerbations despite appropriate airway clearance and management of underlying conditions.

These patients require reassessment of possible contributing factors, including chronic airway infection, treatment technique, other medical conditions, and potentially treatable disease mechanisms.

The 2025 European and 2026 CHEST guidelines recognize the role of selected long-term treatments in patients at increased risk of future exacerbations.

The European Respiratory Society strongly recommends offering long-term macrolide therapy to patients at high risk of exacerbations despite standard care.

It also strongly recommends long-term inhaled antibiotics for patients with chronic Pseudomonas aeruginosa infection who remain at high risk.

The CHEST guideline conditionally supports long-term macrolides and inhaled antibiotics in appropriate patients with frequent exacerbations.

In the CHEST framework, frequent exacerbations generally refer to at least two episodes per year. The European guideline uses a broader risk-based approach that also considers severe exacerbations and substantial daily symptom burden.

These treatments can reduce exacerbation risk, but they are not suitable for everyone.

Macrolides may cause gastrointestinal symptoms, hearing-related adverse effects, cardiac rhythm problems, medication interactions, and antimicrobial resistance.

Appropriate evaluation before treatment may include cardiac, hearing, liver, and microbiological assessment, depending on individual risk.

Nontuberculous mycobacterial infection requires particular attention.

Macrolide monotherapy in a patient with active nontuberculous mycobacterial disease can contribute to clinically important resistance.

For this reason, the European guideline emphasizes appropriate investigation for nontuberculous mycobacterial infection before long-term macrolide treatment begins.

Inhaled antibiotics also require professional oversight. They may cause bronchospasm, involve complex administration routines, and require appropriate equipment and monitoring.

Treatment response, adverse effects, practical burden, and cost should be reviewed rather than assuming that long-term treatment should continue indefinitely.

Another important development is brensocatib, an oral inhibitor of dipeptidyl peptidase 1 that targets pathways involved in neutrophil-mediated airway inflammation.

The phase 3 ASPEN trial, published in The New England Journal of Medicine in April 2025, included 1,721 participants and demonstrated lower annualized rates of pulmonary exacerbations in the brensocatib groups than in the placebo group.

The 2026 CHEST guideline subsequently issued a conditional recommendation supporting brensocatib for selected adults with frequent exacerbations, based on moderate-certainty evidence.

The clinical trial also identified adverse effects, including a higher occurrence of hyperkeratosis among participants receiving the medication.

These findings represent progress in disease-directed treatment, but they do not establish that the medicine is appropriate for every patient.

Brensocatib is a prescription medicine, not a Lifestyle Medicine intervention. Its regulatory approval, indications, availability, prescribing requirements, and reimbursement must be established separately in Viet Nam.

International clinical trial results or foreign regulatory decisions do not independently authorize routine use in Vietnamese healthcare facilities.

Other treatments also require appropriate indications.

Inhaled corticosteroids should not be prescribed routinely for bronchiectasis alone. They may be appropriate when a patient has another condition, such as asthma or chronic obstructive pulmonary disease, for which inhaled corticosteroid treatment is indicated.

For newly isolated Pseudomonas aeruginosa, the European guideline conditionally suggests considering eradication treatment.

The 2026 CHEST guideline found insufficient evidence to recommend either for or against eradication after first isolation.

This difference reflects continuing uncertainty in the evidence and reinforces the need for specialist assessment.

Lifestyle Medicine can support patients through appropriate physical activity, avoidance of harmful exposures, and better participation in long-term care. It should not be presented as an alternative to medically indicated disease-specific treatment.

What Recent Research From Viet Nam Tells Us

Research conducted in Vietnamese healthcare settings is particularly relevant because the underlying causes and clinical characteristics of bronchiectasis may vary across populations.

A multicenter prospective cohort study published on August 27, 2026, in Therapeutic Advances in Respiratory Disease investigated neutrophil elastase activity in bronchial lavage fluid and its relationship with subsequent exacerbations.

The research was conducted at Cho Ray Hospital and University Medical Center Ho Chi Minh City.

Investigators enrolled 139 adults with stable bronchiectasis between April 2022 and January 2024. Of these participants, 121 completed the one-year follow-up.

Post-tuberculosis bronchiectasis was the most frequently identified underlying cause, accounting for 33.1% of the enrolled population.

This finding is relevant to Viet Nam, where previous pulmonary tuberculosis can contribute to persistent structural lung damage.

However, the study involved selected patients undergoing bronchoscopy at two specialist hospitals.

The reported proportion should not be interpreted as the percentage of all bronchiectasis cases in Viet Nam caused by previous tuberculosis.

The investigators measured neutrophil elastase activity in bronchial lavage fluid obtained from radiologically affected and reference bronchial regions.

Neutrophil elastase is an enzyme involved in inflammatory processes and may contribute to airway tissue damage when its activity is excessive.

Median enzyme activity was higher in affected bronchi than in reference regions, at approximately 2.0 versus 0.4 micrograms per milliliter.

During follow-up, 42.1% of the 121 participants with available longitudinal data experienced an exacerbation.

Higher neutrophil elastase activity in affected bronchial regions was associated with greater exacerbation risk after adjustment for selected measures of baseline disease severity.

Participants with higher activity also experienced a shorter time before their first exacerbation.

These findings provide useful evidence about airway inflammation and exacerbation risk in a Vietnamese clinical population.

However, the study was observational.

It did not test whether airway clearance, pulmonary rehabilitation, or another Lifestyle Medicine intervention reduced neutrophil elastase activity or prevented exacerbations.

It also does not establish that bronchial lavage neutrophil elastase testing should become a routine investigation for everyone with bronchiectasis.

Bronchoscopy is an invasive clinical procedure and should be undertaken only when appropriately indicated.

A potentially useful prognostic biomarker is not automatically a suitable screening test or an established basis for treatment decisions.

Further validation is needed before such measurements can be incorporated into routine clinical management.

The study contributes to understanding the biological mechanisms associated with bronchiectasis exacerbations while highlighting opportunities for further research in Viet Nam.

Previous Tuberculosis Requires Particular Attention in Viet Nam

A history of pulmonary tuberculosis is an important consideration when evaluating bronchiectasis in Viet Nam.

Even after successful tuberculosis treatment, some patients experience persistent structural lung abnormalities, including bronchial dilation, scarring, and impaired airway function.

These changes may contribute to chronic cough, sputum production, recurrent infections, and reduced respiratory capacity.

However, post-tuberculosis bronchiectasis must be distinguished from active tuberculosis.

A patient with new or worsening respiratory symptoms, hemoptysis, fever, weight loss, or other concerning features may require investigation for active tuberculosis or another significant respiratory condition.

Previous tuberculosis should not automatically be assumed to explain every subsequent episode of coughing or respiratory deterioration.

Some patients may also require assessment for nontuberculous mycobacterial disease.

Although tuberculosis and nontuberculous mycobacterial disease can share clinical features, their diagnosis, treatment, and public health implications differ.

Ordinary bacterial sputum cultures do not reliably identify mycobacteria. Specific microbiological testing may therefore be necessary when these infections are suspected.

These distinctions are particularly important before prolonged antimicrobial treatment.

Repeated courses of antibiotics without appropriate reassessment may delay recognition of an underlying infection, contribute to antimicrobial resistance, or expose patients to avoidable adverse effects.

For Vietnamese clinical practice, bronchiectasis assessment should connect current symptoms with previous respiratory disease, imaging, microbiology, and other potentially treatable conditions rather than treating every new episode of coughing as another routine infection.

Measuring Outcomes Beyond Cough and Sputum

Cough frequency and sputum production are important measures, but they do not fully describe the burden of bronchiectasis or the effectiveness of treatment.

A patient may report easier expectoration after airway clearance while continuing to experience substantial fatigue or breathlessness.

Another may have relatively stable daily symptoms but develop repeated exacerbations requiring antibiotics or hospitalization.

Follow-up should therefore include complementary clinical and patient-reported outcomes.

Exacerbation frequency and severity, hospital admissions, emergency visits, antimicrobial treatment, and pulmonary function are relevant measures.

Exercise capacity may be assessed using the six-minute walk test or other standardized instruments when clinically appropriate.

Patient-reported outcome measures, including the Quality of Life–Bronchiectasis questionnaire and St. George's Respiratory Questionnaire, may provide information about symptoms, physical functioning, emotional well-being, and treatment burden.

Their use in Viet Nam should consider appropriate translation, cultural relevance, and validation for the population being assessed.

The patient's experience is also important when evaluating airway clearance.

A technique may be useful if it makes secretions easier to clear, reduces the burden of coughing, and can be performed comfortably and consistently.

However, a treatment that takes excessive time, causes discomfort, or requires equipment the patient cannot maintain may provide limited practical benefit.

Healthcare organizations should distinguish between delivering an intervention and demonstrating improvement.

Recording that airway clearance education was provided can help assess service delivery, but it does not prove that symptoms or clinical outcomes improved.

Similarly, completing a pulmonary rehabilitation program does not necessarily establish that exercise capacity increased.

The 2026 CHEST guideline emphasizes treatment burden, quality of life, patient preferences, and shared decision-making as important considerations.

These principles are especially relevant to a chronic condition that may require daily treatment over many years.

For patients, meaningful improvement may include fewer disruptive infections, easier breathing during ordinary activities, greater confidence in self-management, and less uncertainty about when medical assistance is necessary.

A responsible evaluation should consider both the care delivered and the outcomes experienced, while recognizing that several treatments and disease-related factors may influence the results.

Making Bronchiectasis Care Practical in Viet Nam

International recommendations need to be interpreted according to the resources and circumstances in which Vietnamese patients receive care.

Access to respiratory specialists, physiotherapists, microbiological testing, pulmonary rehabilitation, and long-term follow-up may differ between healthcare facilities.

Some patients receive care at tertiary hospitals with established respiratory departments, while others initially attend provincial or local healthcare facilities where specialized bronchiectasis services may be less readily available.

A practical care pathway should begin with accurate diagnosis and identification of the patient's most important clinical problems.

For someone with persistent sputum production or difficulty clearing secretions, appropriate airway clearance assessment and instruction may be a priority.

For a patient with substantial breathlessness or reduced exercise capacity, referral to pulmonary rehabilitation may provide meaningful benefit.

People with repeated exacerbations, chronic infection with important pathogens, significant hemoptysis, or deterioration despite treatment may require specialist reassessment.

These care pathways should not depend entirely on repeated travel to major urban hospitals.

Where clinically appropriate, selected elements of education, follow-up, and professionally supported home-based rehabilitation may be delivered closer to home.

However, remote or home-based support cannot replace direct clinical evaluation when serious respiratory deterioration, significant hemoptysis, oxygenation problems, or other complications are suspected.

Equipment cost and maintenance requirements also influence treatment feasibility.

An expensive airway clearance device may not be the most practical choice when a simpler, appropriately taught technique can provide useful results.

Availability of consumables, cleaning supplies, maintenance services, and qualified professionals may affect whether treatment can be continued safely.

Family members and caregivers may help patients maintain daily routines and recognize concerning symptoms, but they should not be expected to perform specialized respiratory treatment beyond their training.

Clear written information about routine care, signs of exacerbation, when to seek medical advice, and follow-up arrangements may reduce uncertainty.

For healthcare organizations, practical improvements may include more consistent sputum microbiology, appropriate referral for respiratory physiotherapy, better documentation of exacerbations, and clearer communication between inpatient and outpatient services.

The aim is to translate international evidence into coordinated care that is clinically appropriate, feasible, and responsive to patients' circumstances.

Professional Responsibilities and Legal Boundaries in Viet Nam

Lifestyle Medicine can contribute to bronchiectasis care through evidence-based education, appropriate physical activity, smoking cessation support, avoidance of harmful exposures, nutritional care, and assistance with sustainable self-management.

However, diagnosing bronchiectasis, interpreting chest imaging and microbiological findings, prescribing medication, selecting specialized airway clearance techniques, and determining pulmonary rehabilitation safety are regulated clinical activities requiring appropriate qualifications and authorization.

In Viet Nam, the Law on Medical Examination and Treatment No. 15/2023/QH15, together with applicable amendments and implementing regulations, provides the relevant legal framework.

Consolidated Document No. 26/VBHN-VPQH, issued by the Office of the National Assembly on February 26, 2026, reflects the consolidated provisions of the Law.

Healthcare professionals must act within their qualifications, competence, legally authorized professional scope, and applicable institutional responsibilities.

Education or certification in Lifestyle Medicine does not independently authorize someone to diagnose bronchiectasis, prescribe antibiotics, initiate specialized respiratory treatment, or provide individualized pulmonary rehabilitation beyond their permitted professional responsibilities.

Airway clearance and rehabilitation delivered as clinical treatment must involve appropriate assessment, professional oversight, and compliance with applicable healthcare requirements.

The Law on Disease Prevention No. 114/2025/QH15, effective July 1, 2026, provides a broader framework for prevention and health promotion.

However, it does not independently establish Lifestyle Medicine as a newly licensed clinical profession or authorize medical examination and treatment outside existing professional and licensing requirements.

International guidelines from the European Respiratory Society and American College of Chest Physicians can inform professional education, evidence appraisal, and clinical quality improvement.

They do not automatically establish Vietnamese prescribing requirements, regulatory approval, reimbursement, or availability of particular medications, nebulized therapies, medical devices, or healthcare services.

Personal health information also requires appropriate protection.

Respiratory diagnoses, imaging reports, sputum microbiology, pulmonary function findings, medication histories, and identifiable patient experiences must be handled according to applicable confidentiality and personal data protection requirements.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, are relevant to organizations processing identifiable personal health information.

Appropriate safeguards, lawful processing arrangements, and clearly defined responsibilities are necessary when this information is collected, stored, or shared.

For the Vietnam Lifestyle Medicine Alliance, the appropriate role is professional education, scientific knowledge sharing, critical appraisal of evidence, and responsible communication about applying research in healthcare.

Educational articles should not be presented as official Vietnamese clinical practice guidelines, individualized medical advice, or authorization to provide regulated medical treatment.

Connecting Lifestyle Medicine With Comprehensive Bronchiectasis Care

Bronchiectasis illustrates why Lifestyle Medicine needs to remain closely connected to established respiratory care.

Appropriate physical activity, smoking cessation, reduced exposure to harmful substances, adequate nutrition, and sustainable self-management can support overall health and daily functioning.

Airway clearance and pulmonary rehabilitation are important components of care for appropriate patients, but their use requires clinical assessment, suitable instruction, and ongoing review.

The 2025 European Respiratory Society guideline reinforces their role while acknowledging limitations in the certainty of supporting evidence.

The 2026 CHEST guideline adds recommendations concerning individualized airway clearance, antimicrobial treatment, and newer disease-directed therapies for selected patients with frequent exacerbations.

Research from Viet Nam contributes valuable evidence about airway inflammation and exacerbation risk, particularly in a clinical population where previous tuberculosis was a common underlying cause.

These developments also demonstrate the importance of distinguishing what the evidence supports from what remains uncertain.

For healthcare professionals in Viet Nam, an important opportunity is to strengthen the connection between accurate diagnosis, airway clearance, pulmonary rehabilitation, microbiological assessment, and timely treatment of exacerbations.

Lifestyle Medicine can support this process by helping patients maintain beneficial daily behaviors and participate more effectively in their long-term care.

For someone living with bronchiectasis, meaningful progress may involve easier secretion clearance, better exercise tolerance, fewer disruptive exacerbations, and greater confidence in recognizing when additional medical attention is necessary.

These outcomes depend on more than healthy habits alone. They require coordinated care that responds to clinical risks, functional limitations, and the patient's circumstances.

The contribution of evidence-based Lifestyle Medicine is to support that care, helping people maintain their health and daily function without delaying or replacing medically indicated respiratory treatment.

Selected References

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2. Thomson R, Thornton C, Aksamit T, et al. Management of Adult Bronchiectasis: An American College of Chest Physicians Clinical Practice Guideline. CHEST. 2026;170(4):1060–1073. Published online July 21, 2026. doi:10.1016/j.chest.2026.06.057.

3. Mosgrove F, Kocks JWH, Kompatsiari E, et al. The European Respiratory Society Guideline for Adult Bronchiectasis 2025: Summary and Implementation Guide for Primary Care. npj Primary Care Respiratory Medicine. 2026;36:62. doi:10.1038/s41533-026-00528-z.

4. Chalmers JD, Sibila O, Herrero-Cortina B, et al. The European Respiratory Society Guideline for Management of Adult Bronchiectasis: Clinical Summary. Breathe. 2026;22(2):260001. doi:10.1183/20734735.0001-2026. Author-name correction published in Breathe. 2026;22(3):265001. doi:10.1183/20734735.5001-2026.

5. Nguyen-Ho L, Tran-Le QK, Trinh HKT, et al. Neutrophil Elastase Activity in Bronchial Lavage Fluid and the One-Year Follow-Up Outcomes in Bronchiectasis Patients: A Multicenter Prospective Cohort Study. Therapeutic Advances in Respiratory Disease. 2026;20:17534666261473487. Published August 27, 2026. doi:10.1177/17534666261473487.

6. Chalmers JD, Burgel PR, Daley CL, et al. Phase 3 Trial of the DPP-1 Inhibitor Brensocatib in Bronchiectasis. The New England Journal of Medicine. 2025;392(16):1569–1581. doi:10.1056/NEJMoa2411664.

7. De Angelis A, Marrades P, Perea L, et al. The Importance of Symptoms in Bronchiectasis. European Respiratory Review. 2026;35(180):260085. Published June 24, 2026. doi:10.1183/16000617.0085-2026.

8. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. doi:10.1177/15598276251379821.

9. National Assembly of Viet Nam. Law No. 15/2023/QH15, dated January 9, 2023. Law on Medical Examination and Treatment.

10. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH, dated February 26, 2026. Law on Medical Examination and Treatment.

11. National Assembly of Viet Nam. Law No. 114/2025/QH15, dated December 10, 2025. Law on Disease Prevention. Effective July 1, 2026.

12. National Assembly of Viet Nam. Law No. 91/2025/QH15, dated June 26, 2025. Law on Personal Data Protection. Effective January 1, 2026.

13. Government of Viet Nam. Decree No. 356/2025/NĐ-CP, dated December 31, 2025. Detailing Certain Articles and Measures for the Implementation of the Law on Personal Data Protection. Effective January 1, 2026.

Editorial, Clinical and Legal Disclaimer

This article is published by Vietnam Lifestyle Medicine Alliance (VLMA), a physician-led professional education and knowledge-sharing initiative operated by Vietnam Lifestyle Medicine Alliance Company Limited, for general information and professional education. It provides an evidence-informed discussion of Lifestyle Medicine in bronchiectasis care and does not constitute an official clinical practice guideline, individualized medical advice, a respiratory diagnosis, an airway clearance prescription, a pulmonary rehabilitation plan, an antimicrobial treatment protocol, or a medication recommendation.

The information primarily concerns adults with non-cystic fibrosis bronchiectasis. It should not be applied automatically to children, people with cystic fibrosis, or patients with other respiratory conditions without appropriate clinical assessment.

Lifestyle-related interventions may support bronchiectasis management but must not replace necessary respiratory assessment, microbiological investigation, medical treatment, rehabilitation, or specialist care.

The information must not be used to independently diagnose bronchiectasis, interpret imaging or microbiological findings, select or intensify airway clearance techniques, initiate prescription nebulized therapies, prescribe or modify antibiotics, determine individualized pulmonary rehabilitation requirements, or manage exacerbations without appropriate professional assessment.

Patients experiencing new or significant hemoptysis, severe or rapidly worsening breathlessness, chest pain, altered consciousness, suspected respiratory failure, or other serious symptoms require prompt medical evaluation. Significant bleeding or respiratory compromise may require emergency treatment.

Long-term macrolides, inhaled antibiotics, brensocatib, and other disease-specific medications require appropriate clinical indications, safety assessment, and professional monitoring. Discussion of international evidence does not establish the regulatory approval, availability, reimbursement, or suitability of a particular medicine in Viet Nam.

International guidelines do not automatically constitute Vietnamese clinical standards or authorize medical activities outside existing legal and professional requirements.

All regulated clinical activities must be undertaken by appropriately qualified healthcare professionals acting within their legally authorized scope of practice and applicable requirements governing healthcare facilities in Viet Nam.

This article does not endorse any commercial airway clearance device, nebulizer, pharmaceutical product, supplement, rehabilitation program, medical service, or healthcare provider.

Identifiable personal health information must be handled in accordance with applicable confidentiality and personal data protection requirements.

The content reflects the scientific evidence, professional recommendations, and legal sources reviewed as of October 31, 2026, and may require updating as further research, clinical guidance, and Vietnamese regulatory requirements evolve.