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. 2021 Mar 10:8:588584.
doi: 10.3389/fmed.2021.588584. eCollection 2021.

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

Julia E Hartmann  1 , Werner C Albrich  1 , Marija Dmitrijeva  2   3 , Christian R Kahlert  1   4
Affiliations

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

Julia E Hartmann et al. Front Med (Lausanne). .

Abstract

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.

Keywords: airway disease; corticosteroid; diversity; respiratory microbiome; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Parameters of a microbiome: burden, composition, and diversity.
Figure 2
Figure 2
Prisma flow diagram detailing search results and screening process.
Figure 3
Figure 3
ROB 2.0 results quality appraisal of RCTs. ROB 2.0 results of the two included RCTs, both with the result of some concerns in the overall bias.
Figure 4
Figure 4
NOS results quality appraisal of observational studies. NOS results of the three included cohort studies, two with an overall poor rating due to the lack of comparability between cohorts and one with a good rating.
See this image and copyright information in PMC

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