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Review
. 2024 Feb;397(2):751-762.
doi: 10.1007/s00210-023-02681-5. Epub 2023 Aug 31.

Exploring the influence of the microbiome on the pharmacology of anti-asthmatic drugs

Michael Chan  1 , Chloe Ghadieh  1 , Isphahan Irfan  1 , Eamen Khair  1 , Natasha Padilla  1 , Sanshya Rebeiro  1 , Annabel Sidgreaves  1 , Vandana Patravale  2 , John Disouza  3 , Rachelle Catanzariti  1 , Lisa Pont  1 , Kylie Williams  1 , Gabriele De Rubis  1   4 , Samir Mehndiratta  1   4 , Muralikrishnan Dhanasekaran  5 , Kamal Dua  6   7
Affiliations
Review

Exploring the influence of the microbiome on the pharmacology of anti-asthmatic drugs

Michael Chan et al. Naunyn Schmiedebergs Arch Pharmacol. 2024 Feb.

Abstract

The microbiome is increasingly implicated in playing a role in physiology and pharmacology; in this review, we investigate the literature on the possibility of bacterial influence on the pharmacology of anti-asthmatic drugs, and the potential impact this has on asthmatic patients. Current knowledge in this area of research reveals an interaction between the gut and lung microbiome and the development of asthma. The influence of microbiome on the pharmacokinetics and pharmacodynamics of anti-asthmatic drugs is limited; however, understanding this interaction will assist in creating a more efficient treatment approach. This literature review highlighted that bioaccumulation and biotransformation in the presence of certain gut bacterial strains could affect drug metabolism in anti-asthmatic drugs. Furthermore, the bacterial richness in the lungs and the gut can influence drug efficacy and could also play a role in drug response. The implications of the above findings suggest that the microbiome is a contributing factor to an individuals' pharmacological response to anti-asthmatic drugs. Hence, future directions for research should follow investigating how these processes affect asthmatic patients and consider the role of the microbiome on drug efficacy and modify treatment guidelines accordingly.

Keywords: Asthma; Azithromycin; Bioaccumulation; Biotransformation; Corticosteroids; Microbiome; Montelukast; Pharmacotherapy; Resistance; Xenobiotics.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Influence of lung, gut, and colon microbiota on anti-asthmatic drugs. Drugs used to treat asthma are influenced by the microbiome in various physiological systems such as the lungs, colon and gut which influences the pharmacology of these drugs
Fig. 2
Fig. 2
Corticosteroid treatment responsiveness can be predicted by bacterial differential abundance. Bacterial differential abundance is associated with ICS treatment responsiveness, patients with corticosteroid-resistant asthma are associated with a microbial profile enriched in Haemophilus, Neisseria, Fusobacterium, Porphyromonas, and Sphingomonodaceae, whereas there was no association between bacterial richness, evenness of diversity in ICS responsiveness
Fig. 3
Fig. 3
Bacterial interactions with corticosteroids, azithromycin, and montelukast. Bacteria are involved in various processes that affect the pharmacology of drugs. Gut bacteria are capable of biotransforming and bioaccumulating montelukast while montelukast can promote the growth of certain bacteria. Secondly, bacteria have been shown to degrade corticosteroids in the gut. Thirdly, the microbial profile of the lungs is associated with responsiveness to treatment of azithromycin and ICS
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