Keir Holly R, Contoli Marco, Chalmers James D
Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, UK.
Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy.
Biomedicines. 2021 Sep 24;9(10):1312. doi: 10.3390/biomedicines9101312.
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 and . 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.
慢性阻塞性肺疾病全球倡议组织2021年报告建议，对于慢性阻塞性肺疾病（COPD）且频繁急性加重，尤其是伴有嗜酸性粒细胞炎症的患者，含吸入性糖皮质激素（ICS）的治疗方案应作为药物治疗的一部分。然而，真实世界研究显示，无论疾病表现和炎症亚型如何，COPD患者中ICS均存在过度处方的情况，这导致副作用风险增加，主要是呼吸道感染。因此，COPD中ICS的最佳使用仍是一个深入研究的领域，还需要更多获益和风险的生物标志物。尽管COPD中炎症与感染之间的相互作用已得到广泛认可，但微生物群在塑造下呼吸道炎症中的作用直到最近才被探索。新一代测序技术已揭示，COPD疾病进展和急性加重频率与肺部微生物群组成的变化有关，并且ICS的免疫抑制作用可能通过增加细菌载量以及潜在致病菌群（如 和 ）的丰度，导致气道微生物群发生潜在有害变化。在此，我们探讨微生物群、炎症、ICS使用与疾病表型之间的关系。这种关系可能为COPD患者使用ICS的获益风险评估提供依据，并带来更具个性化的药物治疗管理。
