Summary: In this episode our guest is Dr. Robert Dickson a Pulmonologist from the University of Michigan who studies the respiratory microbiome. We discuss how the lung microbiome differs in health, chronic illness and acute disease states like pneumonia, sepsis and ARDS. The lung microbiome has the ability to predict frequency of exacerbations and even severity and progression of certain lung diseases. We’ll explore all of this plus Dr. Dickson’s new paper published last month in Nature Microbiology, which had the surprise of finding gut bacteria in the lungs during critical illness. Please enjoy this wide ranging discussion   Disclosures: Dr. Dickson did not report any disclosures.   Clinical Pearls 1. The lungs are constantly bombarded by microbes and the largest host to microbe interface in the body where bacteria come within millimeters of the blood stream. 2. The lung microbiome is altered in both acute and chronic diseases 3. The lung microbiome is altered by antibiotics, corticosteroids, PPIs and probably lots of other things we are just beginning to discover.   Links from the Show: Dr. Dickson’s latest article reporting gut bacteria in the lungs during critical illnesses. Dickson, R et al. Enrichment of the lung microbiome with gut bacteria in sepsis and the acute respiratory distress syndrome. Nature Microbiology 1, Article number: 16113 (2016). doi:10.1038/nmicrobiol.2016.113   A link to Dr. Dickson’s podcast discussing the role of microbiome and the care and treatment of critically ill patients. The role of microbiome: The Lancet Respiratory Medicine: January 2016   Dr. Dickson’s recent publication in The Lancet. Robert Dickson. The microbiome and critical illness. The Lancet. Published Online: 11 December 2015. DOI: http://dx.doi.org/10.1016/S2213-2600(15)00427-0   Five clinical pearls on the Pulmonary microbiome Robert P. Dickson and Gary B. Huffnagle. The Lung Microbiome: New Principles for Respiratory Bacteriology in Health and Disease. PLoS Pathog. 2015 Jul; 11(7): e1004923. Published online 2015 Jul 9. doi:  10.1371/journal.ppat.1004923 PMCID: PMC4497592   A comprehensive review of the Pulmonary Microbiome field Dickson, RJ et al. The Microbiome and the Respiratory Tract. Annu Rev Physiol. 2016;78:481-504. doi: 10.1146/annurev-physiol-021115-105238. Epub 2015 Nov 2.