This comprehensive review explores the complex interplay between asthma, obesity, and the gut microbiome, focusing on how microbial composition and its metabolites influence immune regulation and disease severity. It highlights the role of the gut–lung axis in asthma pathophysiology, focusing on short-chain fatty acids, gut-derived hormones, and immune signaling pathways. These factors contribute to airway hyperresponsiveness (AHR) and inflammation, particularly in obese individuals. Evidence suggests that specific gut microbes, such as Akkermansia muciniphila, may help modulate asthma severity, while obesity alters gut flora in ways that worsen asthma outcomes. Murine models have shown that manipulating the gut microbiome through antibiotics or microbial transplantation can reverse obesity-induced airway dysfunction, indicating a strong mechanistic connection.
The review also outlines potential therapeutic strategies targeting the gut microbiome in patients with severe asthma and obesity. While most evidence is currently preclinical, early trials have demonstrated changes in microbial diversity and immune markers. However, the clinical efficacy of these interventions remains unproven, with no published trials yet focused on asthma with obesity. Future research is needed to validate these findings in humans and evaluate whether targeted microbiome modulation can reduce exacerbations and improve pulmonary function in this challenging asthma phenotype.
Reference: Tashiro H, Kuwahara Y, Takahashi K. Gut-lung axis in asthma and obesity: role of the gut microbiome. Front Allergy. 2025 Jun 16;6:1618466. doi: 10.3389/falgy.2025.1618466. PMID: 40589493; PMCID: PMC12206879.
