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The practice of medicine has long been looking and doing it the wrong way and anesthesiologists like me have been no saints too. Our practice has been ignoring the role of bugs against bugs for so long that we do not even discuss their role in managing our diseases. However, it is high time that we initiate discussions about manipulating our gut biomes not only in real-life COPD patients but also in all others considering that none's eating behavior has remained the same as what it used to be among our not-too-distant forebears who had evolved fighting and surviving with many more bugs than we are exposed to. The bottom-line is this that future clinical trials as well as clinical practice among real-life COPD patients have to not only include physical barriers like masks and chemical crusaders like antibiotics but also biological guards like prebiotics-probiotics and spiritual guides like stressbusters because without holistic approach, millennials may inexplicably suffer while surviving the onslaught of evolving diseases by overlooking what their forebears had learned to pass on to their descendants over millenniums.
Suggested Reading:
Avalos-Fernandez M, Alin T, Métayer C, Thiébaut R, Enaud R, Delhaes L. The respiratory microbiota alpha-diversity in chronic lung diseases: first systematic review and meta-analysis. Respir Res. 2022;23(1):214. Published 2022 Aug 23. doi:10.1186/s12931-022-02132-4
Millares L, Monso E. The Microbiome in COPD: Emerging Potential for Microbiome-Targeted Interventions. Int J Chron Obstruct Pulmon Dis. 2022;17:1835-1845. Published 2022 Aug 12. doi:10.2147/COPD.S371958
Kotlyarov S. Role of Short-Chain Fatty Acids Produced by Gut Microbiota in Innate Lung Immunity and Pathogenesis of the Heterogeneous Course of Chronic Obstructive Pulmonary Disease. Int J Mol Sci. 2022;23(9):4768. Published 2022 Apr 26. doi:10.3390/ijms23094768
Qu L, Cheng Q, Wang Y, Mu H, Zhang Y. COPD and Gut-Lung Axis: How Microbiota and Host Inflammasome Influence COPD and Related Therapeutics. Front Microbiol. 2022;13:868086. Published 2022 Apr 1. doi:10.3389/fmicb.2022.868086
Ding K, Chen J, Zhan W, et al. Microbiome Links Cigarette Smoke-Induced Chronic Obstructive Pulmonary Disease and Dietary Fiber via the Gut-Lung Axis: A Narrative Review. COPD. 2021;19(1):10-17. doi:10.1080/15412555.2021.2019208
Gokulan K, Joshi M, Khare S, Bartter T. Lung microbiome, gut-lung axis and chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2022;28(2):134-138. doi:10.1097/MCP.0000000000000853
Vaughan A, Frazer ZA, Hansbro PM, Yang IA. COPD and the gut-lung axis: the therapeutic potential of fibre. J Thorac Dis. 2019;11(Suppl 17):S2173-S2180. doi:10.21037/jtd.2019.10.40
Sonnenburg J, Sonnenburg E. The Good Gut: Taking Control of Your Weight, Your Mood, and Your Long-term Health. 1st ed. Penguin Press; 2015.