Key Message:
The type of inhaled corticosteroid (ICS) devices (metered dose inhaler (MDI) versus dry powder inhaler (DPI)) is associated with different saliva microbiome composition in moderate-to-severe pediatric asthma. The findings suggest that inhaler device types should be recognized as potential confounding factors in asthma oral microbiome studies. Furthermore, the results shed light on the potential impact of these devices on the oral microbiota composition, which in turn may affect the frequency and intensity of oral health-related adverse effects.