Microbiomes in respiratory health and disease: An Asia‐Pacific perspective

Abstract

There is currently enormous interest in studying the role of the microbiome in health and disease. Microbiome's role is increasingly being applied to respiratory diseases, in particular COPD, asthma, cystic fibrosis and bronchiectasis. The changes in respiratory microbiomes that occur in these diseases and how they are modified by environmental challenges such as cigarette smoke, air pollution and infection are being elucidated. There is also emerging evidence that gut microbiomes play a role in lung diseases through the modulation of systemic immune responses and can be modified by diet and antibiotic treatment. There are issues that are particular to the Asia-Pacific region involving diet and prevalence of specific respiratory diseases. Each of these issues is further complicated by the effects of ageing. The challenges now are to elucidate the cause and effect relationships between changes in microbiomes and respiratory diseases and how to translate these into new treatments and clinical care. Here we review the current understanding and progression in these areas.

RESPIRE: breathing new life into bronchiectasis

“…Additionally, the different populations in RESPIRE 1 and 2 yielded similar trends toward benefit from ciprofloxacin DPI therapy but probably with different mechanisms at work, including anti-microbial, anti-inflammatory and/or immunomodulatory effects. A clear challenge emerging from RESPIRE and other clinical therapeutic trials in bronchiectasis is the vast ethnic, geographic and endophenotypic heterogeneity of disease [8][9][10][11]. This makes trials in bronchiectasis challenging to perform, analyse and report accurately.…”

“…This results in marked differences in outcomes and treatment responses even within groups classified by a single feature, such as the presence of P. aeruginosa [19]. Future clinical trials for bronchiectasis must consider patient stratification and selection more closely including potential delineation based on airway inflammation and/ or specific components of the lung microbiome [11,[20][21][22]. A systems biology and multi-omics approach, now more widely accessible, presents an opportunity for bronchiectasis, an opportunity to combine these measures with existing clinical, immunological, microbiological and radiological data to achieve a clearer endo-phenotype for an individual patient.…”

The past decade in bench research into pulmonary infectious diseases: What do clinicians need to know?

“…Studies of the lung microbiota to date have tended to focus on chronic respiratory infections, partly because of the ease of access of samples in diseases such as CF and bronchiectasis where sputum is readily accessible . These studies suggest marked variation within individuals in the structure of their microbiota, and surprising stability of microbiota despite exacerbations or antibiotic exposure .…”

“…These studies suggest marked variation within individuals in the structure of their microbiota, and surprising stability of microbiota despite exacerbations or antibiotic exposure . There is a consistent message across multiple diseases that having a diverse and even microbiota, consisting of a range of different bacteria, is associated with health, while disease states, as they become more severe, are associated with a loss of richness and evenness of bacteria; diverse communities are replaced by communities dominated by a few or a single genera (such as Haemophilus or Pseudomonas in CF and bronchiectasis) . Antibiotic treatments, including long‐term antibiotic treatments, are the mainstay of therapy in chronic respiratory infections but this ‘beneficial diversity’ concept raises the possibility that some antibiotic therapies may be harmful.…”

Letter from Singapore

“…4 Despite aggressive anti-tobacco campaigns for decades, documented reduction in smoking rates (to one of the world's lowest) and accessibility to an outstanding healthcare system, rates of COPD, asthma and bronchiectasis continue to rise, contributing morbidity and mortality. Why is this so?…”