The role of the gut microbiome and the gut–lung axis in the allergic bronchial asthma: strategies for prevention and personalized therapy in primary care practice

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Abstract

Allergic bronchial asthma is one of the most significant healthcare challenges, with high comorbidity with other atopic conditions, as reflected in the “unified airway” concept.

This review focuses on the analysis of current evidence regarding the role of the gut–lung axis—a bidirectional communication system that integrates immunological, metabolic, and microbial interactions between the gastrointestinal microbiota and the respiratory system. The article thoroughly examines the influence of perinatal factors on early microbiome development, a critical period for immune maturation. Meta-analyses confirm that cesarean delivery, lack of breastfeeding, and early antibiotic use significantly increase asthma and atopic march risk.

Particular attention is paid to the mechanisms by which gut dysbiosis contributes to Th2-mediated inflammation, including impaired short-chain fatty acids production, lymphocyte migration, and systemic circulation of proinflammatory cytokines.

The article systematizes the evidence supporting the efficacy of microbiome-oriented prevention and therapy strategies. It has been established that specific probiotic strains, such as Lactobacillus rhamnosus HN001 and Bifidobacterium lactis Probio-M8, as well as bacterial lysates (OM-85), improve disease control and reduce the frequency of exacerbations. For primary care physicians, we define patient selection criteria for adjuvant therapy, including those with resistant asthma, gastrointestinal comorbidity, and recurrent respiratory infections. Dietary interventions, namely the Mediterranean diet and fiber intake (25–35 g/day), also show protective effects via immune modulation.

Despite the absence of clear algorithms in current Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, these data substantiate the need to integrate microbiome assessment and corresponding nutritional and metabolic corrections into routine clinical practice to improve allergic bronchial asthma management. The authors conclude that modification of early risk factors and personalized correction of microbiota composition open new prospects for primary prevention and personalized treatment of respiratory allergies.

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About the authors

Alena D. Shatunova

Bashkir State Medical University

Author for correspondence.
Email: shatu-shatu@mail.ru
ORCID iD: 0009-0007-6451-2127
Russian Federation, Ufa

Serafim V. Ermolaev

City Polyclinic No. 7, Kazan

Email: sima_ermolaev@mail.ru
ORCID iD: 0009-0008-6082-8359
Russian Federation, Kazan

Adelya R. Zakirova

Kazan State Medical University

Email: adelazakirova144@gmail.com
ORCID iD: 0009-0000-3427-7989
Russian Federation, Kazan

Maria V. Kuklikhina

Kazan State Medical University

Email: mkuklikhina@bk.ru
ORCID iD: 0009-0004-7671-113X
Russian Federation, Kazan

Kseniya A. Ekkemeeva

Kazan State Medical University

Email: die_gelassenheit@vk.com
ORCID iD: 0009-0006-6075-4754
Russian Federation, Kazan

Yuliya E. Danilenko

Kuban State Medical University

Email: Marikki@mail.ru
ORCID iD: 0009-0005-6301-1043
Russian Federation, Krasnodar

Dmitry A. Maslov

Kuban State Medical University

Email: asimplesmile0@gmail.com
ORCID iD: 0009-0009-9758-0526
Russian Federation, Krasnodar

Irina V. Bryk

Kuban State Medical University

Email: iribryk@mail.ru
ORCID iD: 0009-0009-7407-3812
Russian Federation, Krasnodar

Amalia S. Gusikova

Kuban State Medical University

Email: agusikova123@mail.ru
ORCID iD: 0009-0006-0212-3292
Russian Federation, Krasnodar

Aleksandra S. Lapushkina

Rostov State Medical University

Email: alex4.lapushka@yandex.ru
ORCID iD: 0009-0008-8540-8465
Russian Federation, Rostov-on-Don

Zelimkhan R. Baskhanov

Rostov State Medical University

Email: 95bashanov200295@gmail.com
ORCID iD: 0009-0008-0211-5940
Russian Federation, Rostov-on-Don

Sofia A. Chumakova

Rostov State Medical University

Email: ChumakovaSonya2003@bk.ru
ORCID iD: 0009-0008-3351-7678
Russian Federation, Rostov-on-Don

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Supplementary files

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2. Fig. 1. Methodology for sources selection.

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3. Fig. 2. Formation of the gut microbiome. HMO, human milk oligosaccharides; ОШ, odds ratio.

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4. Fig. 3. Patient selection criteria for microbiome-oriented therapy. ИКС/ДДБА, inhaled corticosteroids/long-acting β₂-agonists; ЖКТ, gastrointestinal tract; СРК, irritable bowel syndrome; ВЗК, inflammatory bowel disease; ОШ, odds ratio; КЦЖК, short-chain fatty acids.

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