Gut-lung axis and microbiome interplay in type 2 high asthma.

INTRODUCTION

Type-2-high (T2-high) asthma remains the most prevalent phenotype of this chronic airway disease. Accumulating evidence implicates the gut-lung microbiome axis as the principal mechanism underlying T2-immune modulation, influencing disease trajectory and therapeutic efficacy.

AREAS COVERED: Following Ferrari's narrative-review framework, a three-stage search of PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library and trial registries (2010-March 2025) was conducted. This review integrates a decade of human and animal investigations in genomics, transcriptomics, metabolomics, and microbiomics. It elucidates cooperative cellular networks in T2-high asthma, traces the hematogenous, lymphatic, and neural conduits conveying gut-derived metabolites the airways, and examines the roles of barrier integrity. The review also included dietary modulation strategies ranging from fiber enrichment and Mediterranean dietary patterns to excessive ultra-processed food intake.

EXPERT OPINION: Near-term translation will pair ICS/LABA/biologics with diet/postbiotics and validated, low-biomass-aware multi-omic panels; adequately powered RCTs and contamination-controlled pipelines are prerequisites for routine care.