Advances in understanding the respiratory microbiome are reshaping the management of respiratory diseases

Bacterial infections play a pivotal role in the development and progression of diverse respiratory diseases, including severe lower respiratory tract infections, cystic fibrosis, and bronchiectasis. Pathogenic bacteria may benefit from interactions with other microbes within their ecological niche, underscoring the critical role of the microbiome in the pathogenesis and persistence of infection. These recent advances reveal that the respiratory microbiome, resistome, and microbial interactome are dynamic systems intricately linked to disease progression, treatment response, and geographic variation. Embracing this complexity will be essential for developing microbiome-informed strategies that improve clinical outcomes, optimize antimicrobial use, and reshape the future of respiratory medicine. Thng KX et al. Sputum metagenomics in bronchiectasis reveals pan-European variation: an EMBARC-BRIDGE study. Eur Respir J. 2025;66:2500054.1 Reviewed by Le-Le Wang Patients with bronchiectasis frequently suffer from bacterial infections,2,3 among which Pseudomonas aeruginosa–dominant microbiomes, both in the upper and lower respiratory tract, are associated with more frequent exacerbations and higher mortality.4-6 Alterations in microbial interactions and reduced microbial diversity also increase the risk of exacerbations.7 While long-term antibiotic use can improve symptoms, it may also promote the development of antibiotic resistance.8