Microbiome-Driven Precision Medicine in Asthma: Roles of Targeted Therapies and Artificial Intelligence.

OBJECTIVE: To evaluate the current evidence regarding airway and gut microbiome alterations in asthma pathogenesis and therapeutic response, and to examine the potential of microbiome-targeted interventions and artificial intelligence (AI)-based precision medicine. DATA SOURCES: A structured narrative literature review was conducted using PubMed, Scopus, and Google Scholar. STUDY SELECTION: Peer-reviewed original research articles, clinical studies, systematic reviews, meta-analyses, and relevant narrative reviews published in English were selected based on their relevance to asthma-associated microbiome dysbiosis, inflammatory endotypes, biologic therapies, and AI-driven analytical approaches. RESULTS: Asthma is a heterogeneous chronic inflammatory airway disease influenced by host immunity, environmental exposures, and alterations in the airway and gut microbiome. Dysbiosis, characterized by enrichment of taxa such as Haemophilus, Moraxella, and Streptococcus and depletion of beneficial commensals, has been associated with corticosteroid resistance, frequent exacerbations, and distinct inflammatory endotypes. Emerging microbiome-targeted interventions, including probiotics, prebiotics, synbiotics, postbiotics, engineered microbial consortia, and phage-based therapies, have demonstrated encouraging findings in preclinical and early clinical studies but require further validation. Biologic therapies targeting IgE, IL-5, IL-4Rα, and thymic stromal lymphopoietin (TSLP) have improved outcomes in selected patients, although variability in treatment response persists. AI and machine-learning approaches integrating microbiome, multi-omic, clinical, and environmental data have shown promise for identifying predictive biomarkers and supporting precision medicine; however, most models remain in the developmental stage and lack robust prospective validation. CONCLUSION: The microbiome and AI hold promise for precision asthma care, although their routine clinical implementation awaits standardized methodologies and large prospective validation studies.