Georgios Belibasakis

It is estimated that over 1 million Swedes have asthma. Approximately 1/3 has uncontrolled, whereas around 5% has severe diagnosis. The treatment of severe asthma requires the use of a high dose of inhaled medications. The side effects of such medications have frequently oral manifestation. The most notable is gingivitis, a clinical sign of compromised oral health. Gingivitis is caused by disturbance of the host-microbe balance of the oral ecosystem (‘dysbiosis’). Since the nasal and oral cavities form a common beginning of the respiratory track, a plausible hypothesis is that oral dysbiosis may trigger respiratory track dysbiosis, consequently exacerbating asthma. While gingivitis is common in asthmatic patients, the dysbiotic interplay between the mouth and the lungs is unknown. Understanding this reciprocal pathogenic process, will optimize asthma assessment, phenotyping and prevention. The Department of Dental Medicine and the Eastman Dental Institute (Folktandvården) are joint collaborators in the project which capitalizes on the SCAPIS-2 national cohort in Stockholm. The originality lies in the clinical aim to concomitantly assess oral and respiratory clinical health, focusing on adult asthmatic patients. Surprisingly, oral and respiratory health assessments are never performed together in healthcare protocols, despite that oral cavity and lungs are in a continuum. By overarching these two assessments, the project will shed light into the interconnection of the clinical status of oral and respiratory conditions. The innovation lies in the biological aim to evaluate the full profile of oral dysbiosis in asthmatic patients. Saliva is optimal for applying combined proteomics and metagenomics to decipher the host protein and microbial profile of the patients. Clinical translation will help physicians identify prognostic factors, optimize asthma phenotyping, and intensify oral healthebased prevention, advocating for wholistic evaluation of respiratory and oral health. Short-term goal is to intensify preventive oral health measures for reducing dysbiosis queues that lead to asthma exacerbation. Monitoring the salivary proteome and microbiome profiles will give added value to the prognostic accuracy of asthma. Mid-term goal is to prevent asthma exacerbations, thus avoiding the need for additional inhaled medications. Long-term goal is to reduce morbidity and mortality of asthmatic patients, contributing to their well-being throughout life.