“…However, only environmental factors are likely able to explain the rapid and increasing societal burden imposed by asthma (van Tilburg Bernardes and Arrieta, 2017). Among these are factors directly and indirectly related to microbial exposures and perturbations during early life, such as respiratory infections (Stein et al, 1999;Busse et al, 2010;Olenec et al, 2010), antibiotic use (Marra et al, 2009;Russell et al, 2012;Patrick et al, 2020), birth by Caesarean section (Thavagnanam et al, 2008;Roduit et al, 2009;Darabi et al, 2019), reduced breastfeeding (Nagel et al, 2009;Kull et al, 2010), urban (vs. farm) upbringing (Wong and Chow, 2008;Lawson et al, 2011;Lawson et al, 2017), and pet exposures (Hugg et al, 2008;Fall et al, 2015). Human studies have linked these factors to distinct patterns of early-life microbial colonization that precede asthma and similar atopic disorders (Bisgaard et al, 2007;Arrieta et al, 2015;Fujimura et al, 2016;Arrieta et al, 2018), suggesting that the large community of microbes that colonize the intestinal and respiratory mucosae is an influential element in asthma pathogenesis.…”