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. 2025 Apr 24:13:1577152.
doi: 10.3389/fped.2025.1577152. eCollection 2025.

Probiotics for children with asthma: a systematic review and meta-analysis

Yang Liu  1   2   3   4 , Yuxiao Zhang  1   2   3   4 , Yingna Li  1   2   3   4 , Xiaohu Zhang  2   5   6 , Liang Xie  1   2   3   4 , Hanmin Liu  1   2   3   4   6
Affiliations

Probiotics for children with asthma: a systematic review and meta-analysis

Yang Liu et al. Front Pediatr. .

Abstract

Background: Asthma is a common chronic inflammatory disease affecting children worldwide. While probiotics have been proposed as a potential therapy, their efficacy in pediatric asthma management remains controversial.

Methods: A systematic search of PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and clinicaltrials.gov was conducted to identify randomized controlled trials (RCTs) from 2014 to 2024 evaluating probiotic interventions in children with asthma. Primary outcomes included asthma exacerbation rates and predicted FEV1%. The risk of bias was assessed using Cochrane guidelines.

Results: Out of 1,361 articles, eight RCTs involving 902 participants were included. Meta-analysis showed probiotics significantly reduced acute asthma episodes with risk ratio of 0.38 (95% CI: 0.26-0.56, p < 0.00001) and improved FEV1/FVC ratios (MD = 5.70, 95% CI: 1.93-9.47, p < 0.003) compared to the control group. Neither FEV1 levels nor school attendance showed significant changes.

Conclusion: Probiotic supplementation may reduce asthma exacerbations and improve pulmonary function in pediatric asthma. However, heterogeneity across studies suggests the need for further research to determine optimal strains, dosages, and treatment durations. This review establishes groundwork for research and practice by exploring microbial interventions in childhood airway disorders.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024607569, identifier (CRD42024607569).

Keywords: asthma; children; meta-analysis; probiotics; pulmonary function.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the stepwise procedure for study selection.
Figure 2
Figure 2
Risk of bias summary (A) and risk of bias graph (B) for included studies.
Figure 3
Figure 3
Forest plots and meta-analysis of RCTs comparing probiotics treatment vs. control group in children with asthma. (A) Comparison of the number of asthma exacerbations between probiotics and control group. (B) Comparison of the results of forced expiratory volume in the first second (FEV1) between probiotics and control group. (C) Comparison of the results of forced expiratory volume in the first second/forced expiratory volume (FEV1/FVC) (%) between probiotics and control group. (D) Comparison of the number of absent from school between probiotics and control group.
Figure 4
Figure 4
Funnel plots for publication bias. (A) Corresponds to Figure 3A: Asthma exacerbations. (B) Corresponds to Figure 3B: FEV1. (C) Corresponds to Figure 3C: FEV1/FVC (%). (D) Corresponds to Figure 3D: school absences.
See this image and copyright information in PMC

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