The lung microbiome and chronic obstructive pulmonary disease: a contemporary perspective on the issue

Background. Chronic obstructive pulmonary disease remains a significant public health problem. Exacerbations of сhronic obstructive pulmonary disease, often caused by bacterial colonization, are the main cause of progression and mortality. The dynamics of bacterial ecology during exacerbations and its role in pathogenesis have not been sufficiently studied. Objectiva. Analysis of modern scientific research and publications on the role of the lung microbiome in the pathogenesis of chronic obstructive pulmonary disease and the possibility of correcting dysbiosis in order to improve the prognosis of patients with сhronic obstructive pulmonary disease during exacerbations. Material and Methods. The analysis of Russian and foreign publications for the period 2010-2025 from the databases PubMed, Google Scholar, RSCI and eLibrary was carried out using the keywords: Chronic obstructive pulmonary disease, microbiota, exacerbation of COPD, antibiotic resistance. Results. Until recently, it was believed that the lungs of healthy people were sterile, so bacterial colonization of the lower respiratory tract was considered only in the context of lung diseases. This belief was based on studies using standard culture methods. However, it has been estimated that more than 70% of the bacterial species on the body surface cannot be cultured using standard methods. The development of culture-independent methods of microbiological analysis has facilitated the identification of uncultivable microbes in the human body and has convincingly demonstrated that the flora inhabiting the bronchopulmonary system is more diverse than previously thought. Studies have shown that the lung microbiome differs between healthy and сhronic obstructive pulmonary disease patients. In patients with сhronic obstructive pulmonary disease, there is a decrease in the diversity of the microbiome and the predominance of commensal bacteria. During the period of exacerbations, low microbial diversity is observed. The use of antibiotics during exacerbations additionally changes the composition of the respiratory microbiota. Conclusion. The use of antibiotics in сhronic obstructive pulmonary disease exacerbations leads to lower respiratory tract dysbiosis and the development of antibiotic resistance. Analysis of the composition of sputum microorganisms makes it possible to develop individual therapy, and correction of the microbiota of the respiratory tract can improve the results of treatment of acute сhronic obstructive pulmonary disease.