This longitudinal study identifies a paradoxical enrichment of Akkermansia during asthma exacerbations in children, challenging the prevailing view of Akkermansia solely as a beneficial microbe and suggesting a complex interaction between gut microbiome and asthma severity.
Key Findings
Results
Children with asthma generally exhibited lower relative abundance of Akkermansia, Anaerostipes, and Escherichia compared to healthy controls.
Study included 82 children with asthma (mean age 6.9 ± 4.1 years) and 91 age- and gender-matched healthy controls (mean age 7.5 ± 2.6 years)
Total of 173 children recruited from the prospective Taiwan Childhood Environment and Allergic Diseases Cohort Study
Gut microbiota composition was assessed using 16S rRNA sequencing
Comparison was made between asthmatic children and healthy controls at the time of fecal sample collection
Results
Relative abundance of Escherichia showed a significant negative correlation with childhood asthma control test (C-ACT) scores.
β = -0.337, p = 0.016
Higher Escherichia abundance was associated with lower (worse) C-ACT scores
C-ACT scores were collected at the time of fecal sample collection as part of phenotypic data
Results
Akkermansia relative abundance exhibited a significant negative correlation with peak expiratory flow (PEF) rates.
β = -0.325, p = 0.032
Higher Akkermansia abundance was associated with lower PEF rates, indicating worse lung function
PEF rates were collected at the time of fecal sample collection as part of phenotypic data
Results
Longitudinal paired case comparisons demonstrated a paradoxical enrichment of Akkermansia during asthma exacerbation phases compared to remission phases.
Linear discriminant analysis (LDA) score = 3.66, p = 0.023
Akkermansia was enriched during asthma attack phases relative to remission phases within the same children
This finding contrasts with the generally lower Akkermansia abundance observed in asthmatic children compared to healthy controls overall
The enrichment was identified through longitudinal paired case comparisons tracking microbial shifts between exacerbation and remission
Discussion
The paradoxical enrichment of Akkermansia during exacerbations may be influenced by high-intensity corticosteroid therapy used during asthma attacks.
Authors suggest the enrichment may be 'potentially influenced by high-intensity corticosteroid therapy'
This finding challenges the one-size-fits-all probiotic approach to asthma management
The authors describe a 'specific severe asthma-associated gut profile characterized by an unexpected enrichment of Akkermansia in children with poor control'
The study highlights the need for 'precision microbiome-based interventions considering asthma phenotypes and medication history'
Discussion
The study identified a complex, context-dependent role for Akkermansia in asthma, contradicting its characterization as a uniformly beneficial microbe.
Authors state the findings are 'in contrast to the prevailing view of Akkermansia solely as a beneficial microbe'
Akkermansia was lower in asthmatic children overall versus healthy controls, yet paradoxically elevated during exacerbations
The dual pattern suggests Akkermansia's role may depend on disease phase, severity, and treatment context
Authors conclude findings 'challenge the one-size-fits-all probiotic approach'
What This Means
This research suggests that the relationship between gut bacteria and asthma in children is more complicated than previously thought. In a study of 173 Taiwanese children, those with asthma generally had lower levels of certain gut bacteria, including Akkermansia, compared to healthy children. Higher levels of the bacterium Escherichia were linked to worse asthma control scores, and higher Akkermansia levels were linked to worse lung function, suggesting that the composition of gut bacteria tracks with how well a child's asthma is managed.
The most striking finding came from following the same asthmatic children over time and comparing their gut bacteria during asthma attacks versus periods of remission. During active asthma attacks, Akkermansia levels actually increased — a result the authors call 'paradoxical' because Akkermansia is widely considered a health-promoting bacterium. The researchers suggest this unexpected rise might be related to the high doses of corticosteroid medications children often receive during severe asthma episodes, which could alter the gut environment in ways that favor Akkermansia growth.
This research suggests that giving all asthma patients Akkermansia as a probiotic supplement — an approach some have proposed — may not be appropriate for every child, particularly those experiencing frequent exacerbations or taking intensive medications. Instead, any microbiome-based treatments for asthma may need to be tailored to a child's specific disease phase, severity, and treatment history. The findings highlight that the same bacterium can play very different roles depending on context, and that understanding the full picture of gut-lung interactions in asthma requires longitudinal studies rather than single time-point snapshots.
Huang C, Wang J, Karmaus W, Wang I. (2026). Paradoxical enrichment of Akkermansia in children with poorly controlled asthma: a longitudinal study.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1807949