Reviews and feature articleThe microbiome in asthma
Section snippets
The airway microbiome in asthma
The idea that bronchial infection might underlie asthma was fostered by epidemiologic studies reporting an association between the development of bronchitis or pneumonia during community outbreaks of Chlamydophila pneumoniae and adult-onset asthma.19 These findings echoed earlier reports that treatment with a macrolide antibiotic was effective in patients with “chronic infectious asthma,”20 the term then applied to asthma associated with chronic mucus hypersecretion that worsens with asthma
The role of environmental and gut microbiota in asthma
Many of the early-life practices, conditions, and exposures associated with lower rates of allergy and asthma seem likely to increase the burden and diversity of exposure to microbes in infancy. These include residence in countries with a predominantly agrarian economy,41 having multiple older siblings,6 breast-feeding,42 growing up in close contact with farm animals,7, 8, 9 early day care attendance,43 consuming farm milk or contaminated water,10, 44 and growing up with pet dogs.11 Some
Relationships of gut microbiota to response to viral respiratory tract infection
In addition to shaping the risk of allergic sensitization, the gut microbiota can also shape responses to viral respiratory tract infection in infancy. The importance of such infections in early life to asthma development was strikingly shown in the Childhood Origins of Asthma Study, a birth cohort study of children of parents with allergies or asthma. Among these children, becoming ill from a viral respiratory tract infection, especially one that is rhinovirus related, in the first year of
Interaction of exposures to environmental allergens and microbes
The observations summarized above can be interpreted as suggesting a causal pathway linking environmental exposures in early infancy to the development of allergy and asthma: (1) environmental exposures shape the composition of the gut microbiota, (2) gut microbiota shape the rate and pattern of development of immune function, and (3) differences in immune function shape the nature and intensity of responsiveness to allergens and viruses encountered. A modification of this argument would be
Microbiome-host relationships in asthma: Key concepts and future challenges
The concept of a “common mucosal immune system” rests on the premise that there is cross-talk between human mucosal compartments and that microbially driven differences in mucosal immune function can be shared across sites. It is also likely true that local immune function, both innate and adaptive, also influences microbiome constitution. Once microbes enter a niche and become established, a balance must be struck that maintains functional homeostasis between the microbiome and the host. This
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Disclosure of potential conflict of interest: Y. J. Huang's and H. A. Boushey's institutions have received funding for studies of the microbiome in asthma from the National Institutes of Health (Y. J. Huang from the National Heart, Lung, and Blood Institute [NHLBI; 105572] and H. A. Boushey from NHLBI U10 HL098115 and the National Institute of Allergy and Infectious Disease [1 UM1 AI114271-01 and P01 AI089473]). Within the past 3 years, H. A. Boushey has received a consultancy fee from Janssen; a grant from Genentech for study of “The Airway Microbiome of Severe Asthma” (A118451); payment for delivering lectures from the Allergy, Asthma, and Immunology Foundation of Northern California; and royalties from McGraw-Hill.