Efficacy of non-pharmacological interventions for childhood asthma: a systematic review and network meta-analysis

Abstract

Background: Childhood asthma is a prevalent chronic respiratory disease. While inhaled corticosteroids and β-agonists remain cornerstone treatments, growing evidence highlights the complementary role of non-pharmacological interventions in improving asthma outcomes. This study aimed to systematically evaluate the efficacy of diverse non-pharmacological approaches through a network meta-analysis (NMA). Methods: Seven English and Chinese databases were searched from their inception to April 1, 2025, for randomized controlled trials (RCTs) related to non-pharmacological intervention in childhood asthma. The risk of bias was assessed using the Cochrane risk of bias tool (ROB). Network meta-analysis was conducted using R 4.2.0 and Stata 14.0 software. Results: A total of 41 studies with 3164 participants were included. Involved structured exercise programs, controlled breathing techniques, traditional moxibustion therapy, psychological interventions, and traditional therapeutic massage adjuvant treatment measures. Five asthma outcome indicators were focused on: FEV1, FVC, PEF, PAQLQ, and FeNO. The ROB was low in the included studies. The NMA of two-by-two comparisons showed that all non-pharmacological adjunctive interventions were able to improve asthma symptoms better, with exercise training improving FEV1 (MD = 3.67, 95%CI [1.39, 5.95]), PEF (MD = 6.07, 95%CI [1.07, 11.07]), and PAQLQ (MD = 0.93, 95%CI [0.33, 1.52]) with statistical significance (p < 0.05). Conclusion: Five non-pharmacological interventions for childhood asthma demonstrated consistent efficacy across all modalities in alleviating asthma symptoms. Psychological interventions emerged as the optimal adjunctive therapy for improving FEV1, while exercise training exhibited the most potent therapeutic effect on FVC. Furthermore, massage therapy demonstrated superior efficacy in enhancing PEF, PAQLQ scores, and FeNO levels.