Key result
Probiotics delay first moderate-to-severe COPD exacerbation by ~50 days and marginally improve FEV1.
Why the study?
Dysbiosis along the gut-lung axis contributes to systemic inflammation and disease progression in COPD, making intestinal microbiome modulation a potential adjunctive management strategy.
Do probiotics or gut-lung axis interventions improve functional capacity, QoL, exacerbation frequency, and spirometry in adults with COPD?
Systematic Review
Do probiotics or gut-lung axis interventions improve functional capacity, QoL, exacerbation frequency, and spirometry in adults with COPD?
Microbiome modulation with probiotics may serve as a beneficial adjunctive strategy to improve functional status and reduce exacerbations in COPD, despite lacking consistent spirometric benefits.
Probiotic blend may ease COPD symptoms; extends gut-lung axis evidence to randomized clinical intervention.
Rationale Chronic obstructive pulmonary disease (COPD) imposes a substantial burden in the United States, with approximately 925,000 COPD-related emergency department visits and over $24 billion in direct medical costs annually among adults ≥45 years. Respiratory and gastrointestinal epithelia share a common embryonic origin in the primitive foregut. Dysbiosis along the gut-lung axis has been linked to systemic inflammation, epithelial barrier disruption, and immune imbalance, contributing to disease progression and exacerbation risk. Increasing evidence supports that modulation of the intestinal microbiome may serve as an adjunctive strategy in long-term COPD management. Methods A structured literature review (database inception-November 2025) was performed across PubMed, Embase, Cochrane Library, medRxiv, and ClinicalTrials.gov to identify randomized controlled trials (RCTs), Mendelian-randomization (MR) studies, observational cohorts, and mechanistic investigations assessing probiotics or gut-lung axis interventions in adults with COPD. Outcomes included functional capacity, quality-of-life (QoL) indices, exacerbation frequency, spirometry, and safety. Results Randomized trials (n = 3; ∼249 participants): A multistrain probiotic improved hand-grip strength, gait speed, and short physical performance battery scores versus placebo, without significant FEV1 change (n = 100). In a multicenter RCT among GOLD D patients (n = 112), Lactobacillus rhamnosus GG delayed time to first moderate-to-severe exacerbation by ∼50 days compared to the conventional treatment group, again without spirometric improvement. A double-blind pilot (n = 37) of a probiotic-herbal blend reported QoL improvement (measured by Saint George’s Respiratory Questionnaire) without FEV1 benefit. All interventions were well tolerated. Observational and genetic data: A NHANES analysis (n = 7,486) associated probiotic/yogurt intake with ∼25% lower COPD incidence with adjusted covariates. Two-sample MR studies identified relationships between the abundance of gut microbiota and metabolite concentrations with protective causal associations linked to COPD, supporting a mechanistic gut-lung interaction. Mechanistic studies: Experimental data demonstrate that enhanced short-chain fatty acids (SCFAs) signalling, reduced IL-17-driven inflammation, and microbial metabolites suppress airway inflammation, modulate corticosteroid responsiveness, and enhance epithelial integrity. Meta-analysis: A 2024 pooled analysis of probiotic interventions showed a small %FEV1 improvement (+3% predicted), aligning with observed functional and symptom gains. Conclusion Preliminary murine, human, and genetic evidence suggests that microbiome-targeted therapies may improve functional status, QoL, and exacerbation timing in COPD, although consistent spirometric benefit remains unproven. Larger, strain-standardized trials with longer follow-up and integrated microbiome profiling are warranted to clarify efficacy, durability, and safety. This abstract is funded by: None
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Sachdeva et al. (2026) conducted a systematic review in Chronic obstructive pulmonary disease (COPD). Probiotics or gut-lung axis interventions vs. Placebo or conventional treatment was evaluated on Functional capacity, quality-of-life (QoL) indices, exacerbation frequency, spirometry, and safety. Probiotic interventions in COPD patients delayed time to first moderate-to-severe exacerbation by ~50 days and showed a small FEV1 improvement of +3% predicted in a pooled analysis.
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