Abstract: Chronic obstructive pulmonary disease (COPD) is a heterogeneous chronic respiratory disorder characterized by persistent airflow obstruction. Its high morbidity and mortality have posed a substantial public health burden, with current symptomatic treatments exhibiting inadequate control and potential adverse effects. With advances in microecological research techniques, the critical role of microbial homeostasis in the oral cavity, lungs, and gut in respiratory health has become increasingly prominent, and microbial dysbiosis is closely associated with progression and therapeutic outcomes of COPD. This review summarizes the compositional alterations of oral, lung, and gut microbiota in COPD patients, analyzes the interactions of the oral-lung axis and gut-lung axis, and delineates three mechanisms through which microbial dysbiosis promotes COPD progression: pathogenic bacterial migration, abnormal metabolite production and immune dysregulation. Additionally, this review summarizes Western and traditional Chinese medicine interventions targeting microbiota homeostasis, including antibiotics, microecological preparations, and herbal medicines, which have shown potential in improving COPD clinical outcomes. This review aims to provide a theoretical reference for the clinical diagnosis and management of COPD. Plain Language Summary: Millions of people worldwide live with chronic obstructive pulmonary disease (COPD), which brings persistent breathing struggles that disrupt their daily living. Current standard treatments mainly relieve symptoms, but have limited effects on controlling disease progression, and may cause unwanted side effects. Mounting research shows that microbes in the mouth, lungs and gut play a critical role in maintaining lung health, while their imbalance can drive COPD progression. This review focused on the link between microbial balance and COPD to find new intervention ideas. We summarized changes in oral, lung, and gut microbes in people with COPD, and clarified how microbial imbalance exacerbates COPD via pathogen spread, abnormal metabolites and immune disorders. We also sorted out Western and traditional Chinese medicine strategies that restore microbial balance to improve COPD treatment and quality of life. These findings show a promising strategy for COPD therapy from the perspective of regulating microbial balance. Keywords: COPD, microbial dysbiosis, oral-lung axis, gut-lung axis, treatment strategies
He et al. (Fri,) studied this question.