A Parent's Guide To Asthma and the Microbiome

A man helps a child use an inhaler for asthma

Summary

Our gut health report gives you deep insights into your baby's gut health. See a sample
Our gut health report gives you deep insights into your baby's gut health. See a sample

Asthma is more than just a medical condition; it's a part of everyday life for many families. If you're a parent, you know how difficult it is to watch your child struggle with wheezing and persistent coughs. You're not alone on this journey. 

While asthma often runs in families, factors like infections, allergens, and diet play big roles. Understanding these triggers can be empowering, as it allows you to better support your child and take control of their health.

One important puzzle piece is the microbiome—the tiny microbes in our gut that shape our immune system. Research shows that imbalances here, especially in early life, can increase the risk of asthma.

Learning about the microbiome can help us find new ways to keep our babies healthy and manage asthma more effectively. Read on to discover how you can help your little one thrive.

What is asthma, and what are its triggers?

Asthma is a chronic respiratory condition characterized by symptoms such as wheezing, shortness of breath, and coughing [1]. In 2021, about 25 million Americans, including 5 million children, were living with asthma. A staggering 63.1% of these children suffered from an asthma attack within that year, highlighting how severely it impacts the pediatric population [2]. 

Over half of those affected by asthma have a genetic predisposition. Children with asthmatic parents are more likely to develop the condition [3], [4]. However, genetics is not the sole factor; environmental triggers such as viral infections, allergens, and tobacco contribute significantly [1]. While the exact cause of asthma remains elusive and complex, recent studies suggest there could be a relationship with the microbiome.

Different types of asthma

Asthma manifests in multiple forms and impacts individuals in unique ways [1]. Below is an overview of the various types of asthma, highlighting the wide range of presentations for this condition [5]. 

Allergic asthma is triggered by allergens such as dust mites, mold, pet dander, pollen, and pest waste. This leads to an immune reaction that causes airway inflammation and symptoms like wheezing, coughing, and shortness of breath.

Nonallergic asthma arises from non-allergenic triggers, including cold air, medications, chemicals, infections, pollution, and tobacco smoke, causing asthma symptoms without an allergic response.

Occupational asthma results from workplace exposure to chemicals or dust, where inhaling irritants triggers airway inflammation and symptoms.

Exercise-induced asthma occurs during physical activity, especially in dry air. It leads to airway constriction and symptoms such as coughing and wheezing.

Nighttime asthma involves symptoms worsening at night, influenced by factors like posture, temperature changes, humidity, or circadian rhythms affecting lung function.

Cough-variant asthma is characterized by a persistent cough as the primary symptom, without the common wheezing or shortness of breath associated with other asthma types.

Allergic asthma, triggered by environmental allergens, is more likely to go into remission or become less severe when it reaches adulthood, most commonly between the ages of 14 and 21 [6]. However, some children with asthma may transition to adult-onset asthma later in life, which has different triggers like hormones, obesity, and occupational exposures. 

Asthma and the microbiome connection

Research points to a close relationship between the microbiome and asthma, suggesting that imbalances in our body's microbial communities could influence asthma's risk, severity, and flare-ups.

The gut microbiome shapes a child's immune system, and imbalance during the crucial first 1,000 days of life has been linked to an increased risk of asthma and other chronic conditions later in childhood [7], [8]. During this period, the baby's immune system is developing, and the gut microbiome plays a key role in [7], [8]:

  • Training the immune system.
  • Acting as a barrier against pathogens.
  • Modulating immune responses through regulatory molecules.

Researchers have identified several factors that influence the newborn's microbiome development that are associated with an increased risk of asthma [1], [7]:

  • Maternal microbiome dysbiosis: Imbalances in the mother's gut microbiome during pregnancy can increase the risk of asthma and other immune disorders in the child.
  • C-section births: Babies born via a C-section have a 20% higher risk of developing asthma compared to those born vaginally.
  • Premature birth: Prematurity is associated with a fourfold increase in asthma risk.
  • Overuse of antibiotics: Antibiotics can disrupt the development of a normal gut microbiome, diminishing beneficial bacteria crucial for immune development.
  • Feeding practices: Formula feeding and late introduction of solid foods can delay the development of a healthy gut microbiome.

Often, parents don’t have a choice in the matter: factors beyond their control may delay a healthy gut microbiome from developing until their child is 4–6 years old. This increases their susceptibility to infections, allergic diseases [7], and the risk of developing asthma.

Identifying an asthma signature in the gut microbiome

Research has found that the gut and lungs of people with asthma often look different than those who don’t have asthma. This suggests a complex link between our microbiome and the risk of developing asthma, its severity, and how often symptoms worsen. Here is what they’ve discovered:

Children at higher risk for asthma tend to have less diversity in their gut microbes by age one, which is related to a greater likelihood of developing asthma by age five [9]. A lack of certain beneficial bacteria immediately after birth and up to 12 months is closely linked to an increased risk of developing asthma later in life [10]. 

Babies who develop asthma typically have lower levels of specific bacteria, such as Akkermansia, Bifidobacterium, Alistipes, Dialister, and Faecalibacterium, early in life [10]. Additionally, the mix of microbes in the lungs differs in people with asthma, with higher amounts of bacteria like Haemophilus, Klebsiella, and Moraxella, while bacteria such as Prevotella are more common in healthy people without asthma [11].

The only way to know the diversity and the amount of beneficial bacteria in your little one’s gut is to test. With Tiny Health’s Baby Gut Program and Child Gut Program, our microbiome specialists can help you course-correct if the results uncover gut imbalances.

Asthma development - the last step in the atopic march 

The atopic march, a concept first introduced in the 1920s, refers to the sequential development of allergic diseases that typically start in early childhood. This progression often begins with atopic dermatitis (eczema), a chronic skin condition marked by itching and irritation, and can advance to food allergies, allergic rhinitis (hay fever), and eventually asthma [12], [13]. 

Asthma is considered the last step in the atopic march, with around 70% of patients with severe eczema later developing asthma. In contrast, only 20–30% of those with mild eczema and about 8% of the broader population end up developing asthma [12]. Although the disease frequently manifests in early childhood—nearly 80% of cases emerge in the first six years of life—adults are not exempt from developing it [12], [14].

The gut-lung axis

Another emerging concept that helps us understand asthma is the gut-lung axis (GLA). This connection helps explain the two-way relationship between the gut and lung microbiomes, their impact on our immune system, and their relationships to respiratory diseases like asthma [15], [16]. 

While the exact ways the gut affects lung health are still being studied, the impact of an imbalanced gut on respiratory health is significant. Evidence shows that an imbalanced gut microbiome can disrupt the connection between the gut and the lungs, making a person more prone to respiratory infections and diseases.

Top 5 ways to support gut health in newborns and children 

To support a baby’s gut microbiome and help prevent the development of asthma, these practices are highly beneficial to their overall health and development:

  1. Breastfeeding: Breastfeeding introduces beneficial bacteria like Bifidobacterium and Lactobacillus from mother to infant.
  2. Skin-to-skin contact: Immediate post-birth skin-to-skin contact facilitates the transfer of beneficial microbes.
  3. Pre- and probiotic supplementation: With the right interventions, especially during the first 1,000 days, restoring a healthy gut can help counteract risk factors like C-section and antibiotic use. Our Baby’s Gut Program can help you with personalized recommendations for your child’s unique microbiome. 
  4. Avoid unnecessary antibiotics: It will help maintain natural microbiome development.
  5. Spend time in nature: Exposure to soil and farm animals can help children develop a strong and balanced immune system.

As your child gets older, these nutritional and lifestyle practices are also beneficial:

  • Diverse diet: Encourage a diet rich in colorful fruits, vegetables, whole grains, and legumes. These high-fiber foods can promote the growth of beneficial gut bacteria.
  • Probiotics and prebiotics: Include foods high in beneficial bacteria and fibers.
  • Regular physical activity and adequate sleep: Support gut health and overall well-being.

A holistic approach to managing asthma

As research unravels the intricate connections between our microbiome, immune system, and respiratory health, the hope is to pave the way for more targeted and effective strategies for asthma.

Asthma is complex. And learning about its connection to the atopic march and the microbiome offers a new perspective. Early-life interventions such as breastfeeding, avoiding unnecessary antibiotics, and addressing imbalances in the microbiome can help reduce the risk of asthma and other related allergic conditions, providing hope to parents managing this challenging condition.

If you're a parent seeing early symptoms and trying to stop the atopic march, our Baby's Gut Program can provide science-backed insights to identify and address imbalances in your little one's gut. By getting to the root causes of their symptoms with guidance from our microbiome specialists and a personalized action plan, you're taking an essential step in supporting your child's lifelong well-being. And we're here for you every step of the way, helping you make informed decisions about your child's wellness.

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References

[1] S. T. Holgate, S. Wenzel, D. S. Postma, S. T. Weiss, H. Renz, and P. D. Sly, “Asthma,” Nat Rev Dis Primers, vol. 1, no. 1, p. 15025, Sep. 2015, doi: 10.1038/nrdp.2015.25.

[2] “2021 National Health Interview Survey (NHIS) Data,” Aug. 04, 2023. https://www.cdc.gov/asthma/nhis/2021/data.htm (accessed Feb. 26, 2024).

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[4] S. F. Thomsen, “Genetics of asthma: an introduction for the clinician,” Eur. Respir. J., vol. 2, Jan. 2015, doi: 10.3402/ecrj.v2.24643.

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[6] M. Trivedi and E. Denton, “Asthma in Children and Adults-What Are the Differences and What Can They Tell us About Asthma?,” Front Pediatr, vol. 7, p. 256, Jun. 2019, doi: 10.3389/fped.2019.00256.

[7] S. M. Langan, A. D. Irvine, and S. Weidinger, “Atopic dermatitis,” Lancet, vol. 396, no. 10247, pp. 345–360, Aug. 2020, doi: 10.1016/S0140-6736(20)31286-1.

[8] Y. Mehta and D. G. Fulmali, “Relationship Between Atopic Dermatitis and Food Allergy in Children,” Cureus, vol. 14, no. 12, p. e33160, Dec. 2022, doi: 10.7759/cureus.33160.

[9] J. Stokholm et al., “Maturation of the gut microbiome and risk of asthma in childhood,” Nat. Commun., vol. 9, no. 1, p. 141, Jan. 2018.

[10] J. Durack et al., “Delayed gut microbiota development in high-risk for asthma infants is temporarily modifiable by Lactobacillus supplementation,” Nat 

[11] J. Valverde-Molina and L. García-Marcos, “Microbiome and Asthma: Microbial Dysbiosis and the Origins, Phenotypes, Persistence, and Severity of Asthma,” Nutrients, vol. 15, no. 3, Jan. 2023, doi: 10.3390/nu15030486.

[12] S. K. Bantz, Z. Zhu, and T. Zheng, “The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma,” J. Clin. Cell. Immunol., vol. 5, no. 2, Apr. 2014, doi: 10.4172/2155-9899.1000202.

[13] D. A. Hill and J. M. Spergel, “The atopic march: Critical evidence and clinical relevance,” Ann. Allergy Asthma Immunol., vol. 120, no. 2, pp. 131–137, Feb. 2018, doi: 10.1016/j.anai.2017.10.037

[14] H. A. Hadi, A. I. Tarmizi, K. A. Khalid, M. Gajdács, A. Aslam, and S. Jamshed, “The Epidemiology and Global Burden of Atopic Dermatitis: A Narrative Review,” Life, vol. 11, no. 9, Sep. 2021, doi: 10.3390/life11090936.

[15] S. P. Wiertsema, J. van Bergenhenegouwen, J. Garssen, and L. M. J. Knippels, “The Interplay between the Gut Microbiome and the Immune System in the Context of Infectious Diseases throughout Life and the Role of Nutrition in Optimizing Treatment Strategies,” Nutrients, vol. 13, no. 3, Mar. 2021, doi: 10.3390/nu13030886.

[16] D. Zheng, T. Liwinski, and E. Elinav, “Interaction between microbiota and immunity in health and disease,” Cell Res., vol. 30, no. 6, pp. 492–506, Jun. 2020, doi: 10.1038/s41422-020-0332-7.