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Inhaled Corticosteroids and the Lung Microbiome in COPD
The Global Initiative for Chronic Obstructive Lung Disease 2021 Report recommends inhaled corticosteroid (ICS)-containing regimens as part of pharmacological treatment in patients with chronic obstructive lung disease (COPD) and frequent exacerbations, particularly with eosinophilic inflammation. Ho...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8533282/ https://www.ncbi.nlm.nih.gov/pubmed/34680429 http://dx.doi.org/10.3390/biomedicines9101312 |
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author | Keir, Holly R. Contoli, Marco Chalmers, James D. |
author_facet | Keir, Holly R. Contoli, Marco Chalmers, James D. |
author_sort | Keir, Holly R. |
collection | PubMed |
description | The Global Initiative for Chronic Obstructive Lung Disease 2021 Report recommends inhaled corticosteroid (ICS)-containing regimens as part of pharmacological treatment in patients with chronic obstructive lung disease (COPD) and frequent exacerbations, particularly with eosinophilic inflammation. However, real-world studies reveal overprescription of ICS in COPD, irrespective of disease presentation and inflammatory endotype, leading to increased risk of side effects, mainly respiratory infections. The optimal use of ICS in COPD therefore remains an area of intensive research, and additional biomarkers of benefit and risk are needed. Although the interplay between inflammation and infection in COPD is widely acknowledged, the role of the microbiome in shaping lower airway inflammation has only recently been explored. Next-generation sequencing has revealed that COPD disease progression and exacerbation frequency are associated with changes in the composition of the lung microbiome, and that the immunosuppressive effects of ICS can contribute to potentially deleterious airway microbiota changes by increasing bacterial load and the abundance of potentially pathogenic taxa such as Streptococcus and Haemophilus. Here, we explore the relationship between microbiome, inflammation, ICS use and disease phenotype. This relationship may inform the benefit:risk assessment of ICS use in patients with COPD and lead to more personalised pharmacological management. |
format | Online Article Text |
id | pubmed-8533282 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-85332822021-10-23 Inhaled Corticosteroids and the Lung Microbiome in COPD Keir, Holly R. Contoli, Marco Chalmers, James D. Biomedicines Review The Global Initiative for Chronic Obstructive Lung Disease 2021 Report recommends inhaled corticosteroid (ICS)-containing regimens as part of pharmacological treatment in patients with chronic obstructive lung disease (COPD) and frequent exacerbations, particularly with eosinophilic inflammation. However, real-world studies reveal overprescription of ICS in COPD, irrespective of disease presentation and inflammatory endotype, leading to increased risk of side effects, mainly respiratory infections. The optimal use of ICS in COPD therefore remains an area of intensive research, and additional biomarkers of benefit and risk are needed. Although the interplay between inflammation and infection in COPD is widely acknowledged, the role of the microbiome in shaping lower airway inflammation has only recently been explored. Next-generation sequencing has revealed that COPD disease progression and exacerbation frequency are associated with changes in the composition of the lung microbiome, and that the immunosuppressive effects of ICS can contribute to potentially deleterious airway microbiota changes by increasing bacterial load and the abundance of potentially pathogenic taxa such as Streptococcus and Haemophilus. Here, we explore the relationship between microbiome, inflammation, ICS use and disease phenotype. This relationship may inform the benefit:risk assessment of ICS use in patients with COPD and lead to more personalised pharmacological management. MDPI 2021-09-24 /pmc/articles/PMC8533282/ /pubmed/34680429 http://dx.doi.org/10.3390/biomedicines9101312 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Keir, Holly R. Contoli, Marco Chalmers, James D. Inhaled Corticosteroids and the Lung Microbiome in COPD |
title | Inhaled Corticosteroids and the Lung Microbiome in COPD |
title_full | Inhaled Corticosteroids and the Lung Microbiome in COPD |
title_fullStr | Inhaled Corticosteroids and the Lung Microbiome in COPD |
title_full_unstemmed | Inhaled Corticosteroids and the Lung Microbiome in COPD |
title_short | Inhaled Corticosteroids and the Lung Microbiome in COPD |
title_sort | inhaled corticosteroids and the lung microbiome in copd |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8533282/ https://www.ncbi.nlm.nih.gov/pubmed/34680429 http://dx.doi.org/10.3390/biomedicines9101312 |
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