Pathogen Dynamics and Airway Microbiome in Pulmonary Diseases: From Conservative Management to Interventional Therapies

Dear Colleagues,

The airway microbiome has emerged as a key modulator of respiratory health and disease. It contributes to immune homeostasis, barrier integrity, and pathogen defense, while its disruption, termed microbial dysbiosis, has been increasingly implicated in the pathogenesis and progression of chronic pulmonary diseases, including chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, and idiopathic pulmonary fibrosis (IPF). Dysbiosis is associated with recurrent exacerbations, heightened inflammatory responses, and diminished therapeutic efficacy.

While conservative management (e.g., pharmacotherapy, oxygen therapy, pulmonary rehabilitation) remains the mainstay for many of these conditions, a subset of patients with advanced or complicated disease may require interventional pulmonary procedures such as airway stenting, tracheostomy, photodynamic therapy (PDT), or cryoablation to address airway obstruction, tumor burden, or refractory symptoms. Emerging evidence suggests that such interventions can substantially reshape the local microbiome, alter pathogen colonization dynamics, and influence antimicrobial resistance profiles.

However, the longitudinal and comparative dynamics of microbial shifts, spanning both conservative and interventional treatment contexts, remain poorly characterized. Critical knowledge gaps persist regarding the persistence or reversibility of microbial alterations, the emergence of resistant organisms, and the role of environmental exposures (e.g., hospital air, equipment surfaces) in modulating microbial–host interactions in these clinical settings.

This Special Issue aims to integrate insights from respiratory medicine, microbiology, and environmental health to better understand how different pulmonary disease management strategies, ranging from conservative care to interventional procedures, shape airway pathogen ecology and influence clinical outcomes. We invite interdisciplinary submissions from clinicians, epidemiologists, environmental scientists, and public health researchers.

Topics of interest include, but are not limited to, the following:

• Airway microbiome remodeling and pathogen colonization following interventional therapies (e.g., airway stents, PDT, cryoablation, tracheostomy);
• Antimicrobial resistance development and biofilm formation associated with respiratory devices or procedural interventions;
• Dysbiosis and pathogen dynamics in conservatively managed chronic lung diseases (COPD, asthma, bronchiectasis, pulmonary fibrosis);
• Host–microbiome–pathogen interactions driving disease exacerbation or therapeutic response;
• Microbiome profiling (e.g., 16S rRNA, metagenomics) approaches to explore microbial dynamics in clinical and environmental contexts;
• Environmental and nosocomial microbial exposures (e.g., hospital microbiota, air quality, ventilation systems) and their influence on respiratory colonization and infection risk.

Dr. Jing Gao
Dr. Chutian Zhang
Guest Editors

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• airway microbiome
• pulmonary diseases
• interventional pulmonology
• pathogen dynamics
• antimicrobial resistance