The Effects of Corticosteroids on the Respiratory Microbiome: A Systematic Review

Hartmann, Julia Evelyn; Albrich, Werner C.; Dmitrijeva, Marija; Kahlert, Christian

doi:10.21203/rs.3.rs-28779/v1

Cited by 3 publications

(4 citation statements)

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“…Importantly, within asthmatic subjects we did not find current ICS use to be associated with additional microbial abnormalities. The presence or absence of ICS induced changes in the bacterial microbiota is contentious [58] , but our results are consistent with controlled studies of steroid and antibiotic naïve wheezing infants [59] and adults with steroid-naive atopic asthma [60] . We were not able to inform on ICS effects in the thoracic airways or in more severe disease.…”

Section: Discussionsupporting

confidence: 89%

Airway microbial communities, smoking and asthma in a general population sample

et al. 2021

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Background Normal airway microbial communities play a central role in respiratory health but are poorly characterized. Cigarette smoking is the dominant global environmental influence on lung function, and asthma has become the most prevalent chronic respiratory disease worldwide. Both conditions have major microbial components that are incompletely defined. Methods We investigated airway bacterial communities in a general population sample of 529 Australian adults. Posterior oropharyngeal swabs were analyzed by sequencing of the 16S rRNA gene. The microbiota were characterized according to their prevalence, abundance and network memberships. Findings The microbiota were similar across the general population, and were strongly organized into co-abundance networks. Smoking was associated with diversity loss, negative effects on abundant taxa, profound alterations to network structure and expansion of Streptococcus spp. By contrast, the asthmatic microbiota were selectively affected by an increase in Neisseria spp. and by reduced numbers of low abundance but prevalent organisms. Interpretation Our study shows that the healthy airway microbiota in this population were contained within a highly structured ecosystem, suggesting balanced relationships between the microbiome and human host factors. The marked abnormalities in smokers may contribute to chronic obstructive pulmonary disease (COPD) and lung cancer. The narrow spectrum of abnormalities in asthmatics encourages investigation of damaging and protective effects of specific bacteria. Funding The study was funded by the Asmarley Trust and a Wellcome Joint Senior Investigator Award to WOCC and MFM (WT096964MA and WT097117MA). The Busselton Healthy Ageing Study is supported by the Government of Western Australia (Office of Science, Department of Health) the City of Busselton, and private donations.

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Section: Discussionsupporting

confidence: 89%

Airway microbial communities, smoking and asthma in a general population sample

et al. 2021

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“…Hartmann et al performed a systematic review and reported that corticosteroids may have an important effect on the composition of the respiratory microbiome, but there was no clear shared direction as a result of the heterogeneous nature of the methods used and the populations investigated. 15 The effect of ICS on the microbiome, especially mycobiome and bacterial-fungal, fungal-fungal, and bacterial-bacterial networks, remains to be elucidated. In this study we aimed to investigate the effect of ICS on the airway microbiome and microbial connections in asthma patients over a 9-month period.…”

Section: Introductionmentioning

confidence: 99%

“…Different inhaled ICS showed different effects on the lung microbiome, although different inhaled ICS may have similar effects on the phagocytic function of macrophages in animal experiments. Hartmann et al performed a systematic review and reported that corticosteroids may have an important effect on the composition of the respiratory microbiome, but there was no clear shared direction as a result of the heterogeneous nature of the methods used and the populations investigated 15 . The effect of ICS on the microbiome, especially mycobiome and bacterial–fungal, fungal–fungal, and bacterial–bacterial networks, remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Effect of inhaled corticosteroids on microbiome and microbial correlations in asthma over a 9‐month period

Huang

et al. 2022

Clinical Translational Sci

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The effect of inhaled corticosteroids (ICS) on the airway microbiome requires longitudinal research for corroboration. Asthma patients, not undergoing ICS treatment (baseline), were enrolled and prescribed ICS; all these patients were followed up with regular visits at 3 months (visit 1) and 9 months (visit 2). Induced sputum was collected, and fungal microbiota (mycobiome) and bacterial microbiota (bacteriome) were estimated using 16S rRNA and internal transcribed spacer (ITS) sequencing. Bacterial α diversity indices were not significantly different between baseline, visit 1, and visit 2. Visit 1 showed lower fungal evenness than the baseline, and visit 2 showed lower fungal diversity and evenness than the baseline. Fungal, but not bacterial, community compositions differed significantly between the baseline, visit 1, and visit 2. The most abundant bacterial phyla and genera did not differ significantly between the baseline, visit 1, and visit 2. Compared with the baseline, visit 1 showed significantly increased frequency of the fungal phylum Ascomycota and lower frequency of Basidiomycota. We found sharply decreased fungal genera Wallemia, Cladosporium, Penicillium, and Alternaria at visit 1 and visit 2 compared with the baseline, although the differences were not statistically significant. We also found the proportion of Basidiomycota was positively correlated with percentages of sputum eosinophils and neutrophils. The proportions of Saccharomyces, Wallemia, and Aplosporella were positively correlated with percentage of sputum eosinophils. Moreover, we identified distinct inter-and intra-kingdom interactions in baseline, visit 1, and visit 2. Therefore, ICS use altered the airway microbial diversity, evenness, community composition, and microbial connections. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?Previous studies have reported on the associations of bacteriome and asthma; however, no longitudinal studies have examined the correlations between inhaled corticosteroid (ICS) use and airway bacteriome, mycobiome, and microbial interactions.

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“…We thank PD Dr. Christian Appenzeller-Herzog of the University of Basel for significant contributions in the planning and early execution stages of this systematic review. This manuscript has been released as a pre-print at Research Square ( 45 ).…”

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The Effects of Corticosteroids on the Respiratory Microbiome: A Systematic Review

et al. 2021

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Background: Since its discovery, the respiratory microbiome has been implicated in the pathogenesis of multiple pulmonary diseases. Even though corticosteroid treatments are widely prescribed for pulmonary diseases, their effects on the respiratory microbiome are still poorly understood. This systematic review summarizes the current understanding of the effects of corticosteroids on the microbiome of the airways.Research Question: How does treatment with corticosteroids impact the respiratory microbiome?Study Design and Methods: According to the PRISMA guidelines, Embase, Medline, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched for all observational or randomized-controlled studies comparing the microbiome parameters of patients receiving corticosteroids to those of controls. The primary outcomes of interest were changes in the diversity, composition and total burden of the respiratory microbiome as assessed by culture-independent molecular methods.Results: Out of 1,943 identified reports, five studies could be included: two on patients with asthma, two on patients with chronic obstructive pulmonary disease and one on patients with chronic rhinosinusitis. The studies were highly heterogeneous with regards to the methods used and the populations investigated. Microbiome diversity increased with corticosteroids at least transiently in three studies and decreased in one study. The effects of corticosteroids on the composition of the respiratory microbiome were significant but without a clear shared direction. A significant increase in microbial burden after corticosteroids was seen in one study.Interpretation: Data on the effect of corticosteroids on the respiratory microbiome are still limited, with considerable heterogeneity between studies. However, available data suggest that corticosteroid treatment may have significant effects on the composition and possibly the diversity of the respiratory microbiome. Further research is needed to better understand the influence of corticosteroids on the respiratory microbiome and thus better target its widespread therapeutic use.

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The Effects of Corticosteroids on the Respiratory Microbiome: A Systematic Review

Cited by 3 publications

References 42 publications

Airway microbial communities, smoking and asthma in a general population sample

Airway microbial communities, smoking and asthma in a general population sample

Effect of inhaled corticosteroids on microbiome and microbial correlations in asthma over a 9‐month period

The Effects of Corticosteroids on the Respiratory Microbiome: A Systematic Review

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