The effects of obesity, diet, and exercise in asthma: a review

Abstract

Obesity is a determinant of the risk of developing various diseases, including asthma. It can also contribute to asthma severity. Obvious determinants of the risk of developing obesity and conditions associated with obesity are the diet an individual consumes and their energy expenditure, as determined by activity. Therefore, diet and exercise are important non-pharmacological components in the management and prevention of many diseases. Several individual elements in diet, including certain fatty acids and vitamins, as well as types of diets, notably the Mediterranean diet, have been studied in asthmatic patients, but the literature is not consistent. This review explores the relationship between asthma and obesity, exercise, and multiple dietary components and regimens, including the Mediterranean diet; polyunsaturated fats; vitamins A, C, D, and E; flavonoids; probiotics; and sodium intake in the published randomized clinical trials. Overall, the data have many shortcomings, but there is no single component of diet that is consistently associated with improved asthma outcomes, nor any component found to be clearly harmful. However, a diet that helps an individual lose weight may indirectly improve their lung function and asthma control, even if the diet itself does not impact asthma outcomes. Exercise, now known to be safe and widely recommended in asthma, has various forms. This review looked at meta-analyses, as well as recently published data addressing this question, categorizing exercise as aerobic activity, pulmonary rehabilitation, and yoga. The most evidence for benefit is for aerobic exercise, but yoga also has potential for modest improvement in asthma symptoms. There is conflicting data as to whether supervised exercise programs are superior to unsupervised physical activity. Overall, exercise is helpful in asthma, but it is still unclear how much exercise should be done, and this should be tailored to each individual.

Keywords

asthma / diet / exercise / Mediterranean / obesity / aerobic

References

[1] Chang YJ, Heilbronn LK, Hutchison AT. Established dietary interventions and time—restricted eating for cardiovascular disease prevention. Cell Rep Med. 2025; 6:102326.

[2] Collignon TE, Bishayee A . Cancer Prevention and Therapy With Nutritional Science: Addressing the Gap in Medical Education and Practice. MedComm (2020). 2025; 6:e70417.

[3] Joerns EK, Sparks JA, Chelf CJ, Crowson CS, Davis JM 3rd, Kronzer VL. Healthy dietary pattern and risk of rheumatoid arthritis: A systematic review and meta—analysis. Semin Arthritis Rheum. 2025; 74:152825.

[4] Thien FC, Woods RK, Walters EH. Oily fish and asthma——a fishy story? Further studies are required before claims can be made of a beneficial effect of oily fish consumption on asthma. Med J Aust. 1996; 164:135—6.

[5] Liu W, Feng Z, Song S, Lei S. The effectiveness of physical activity in asthma management: An overview of systematic reviews. PLoS One. 2025; 20:e0325488.

[6] Cordova—Rivera L, Gibson PG, Gardiner PA, McDonald VM . A Systematic Review of Associations of Physical Activity and Sedentary Time with Asthma Outcomes. J Allergy Clin Immunol Pract. 2018; 6:1968-81.e2.

[7] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71.

[8] Zhang P. The Role of Diet and Nutrition in Allergic Diseases. Nutrients. 2023; 15:3683.

[9] Miethe S, Guarino M, Alhamdan F, Simon H, Renz H, Dufour J, et al. Effects of obesity on asthma: immunometabolic links. Pol Arch Intern Med. 2018; 128:469-77.

[10] Chinn S. Asthma and obesity: where are we now? Thorax. 2003; 58:1008—10.

[11] Aaron SD, Vandemheen KL, Boulet LP, McIvor RA, Fitzgerald JM, Hernandez P, et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ. 2008; 179:1121-31.

[12] Brumpton BM, Leivseth L, Romundstad PR, Langhammer A, Chen Y, Camargo CA Jr, et al. The joint association of anxiety, depression and obesity with incident asthma in adults: the HUNT study. Int J Epidemiol. 2013; 42:1455-63.

[13] Zhu H, Yi X, He M, Wu S, Li M, Gao S. Childhood Obesity and Age—Related Diseases: A Systematic Review and Meta—Analysis of Mendelian Randomization Evidence. Pediatr Obes. 2026; 21:e70071.

[14] Corvera S, Rajan A, Townsend KL, Shamsi F, Wu J, Svensson KJ, et al. Advances in Adipose Tissue Biology. Endocr Rev. 2026; 47:75-92.

[15] Sukanya E, Ponnazhagan, Ganesh V. A review on impact of adipocytokines in post postmenopausal women. Bioinformation. 2025; 21:1906—11.

[16] Tilg H, Ianiro G, Gasbarrini A, Adolph TE. Adipokines: masterminds of metabolic inflammation. Nat Rev Immunol. 2025; 25:250-65.

[17] Lee AA, Den Hartigh LJ. Metabolic impact of endogenously produced estrogens by adipose tissue in females and males across the lifespan. Front Endocrinol (Lausanne). 2025; 16:1682231.

[18] Kaczyńska K, Zając D, Wojciechowski P, Jampolska M. Regulatory Peptides in Asthma. Int J Mol Sci. 2021; 22:13656.

[19] Jiang Z, Tabuchi C, Gayer SG, Bapat SP. Immune Dysregulation in Obesity. Annu Rev Pathol. 2025; 20:483-509.

[20] Cuevas—Sierra A, Ramos—Lopez O, Riezu—Boj JI, Milagro FI, Martinez JA. Diet, Gut Microbiota, and Obesity: Links with Host Genetics and Epigenetics and Potential Applications. Adv Nutr. 2019; 10:S17-30.

[21] Berg AH, Scherer PE . Adipose tissue, inflammation, and cardiovascular disease. Circ Res. 2005; 96:939-49.

[22] Peters MC, McGrath KW, Hawkins GA, Hastie AT, Levy BD, Israel E, et al. Plasma interleukin—6 concentrations, metabolic dysfunction, and asthma severity: a cross—sectional analysis of two cohorts. Lancet Respir Med. 2016; 4:574-84.

[23] Davidson WJ, Mackenzie—Rife KA, Witmans MB, Montgomery MD, Ball GDC, Egbogah S, et al. Obesity negatively impacts lung function in children and adolescents. Pediatr Pulmonol. 2014; 49:1003—10.

[24] Rabec C, Janssens J, Murphy PB. Ventilation in the obese: physiological insights and management. Eur Respir Rev. 2025; 34:240190.

[25] Zouein J, Que LG, Ingram JL. Obesity—driven airway eosinophilia and neutrophilia in asthma. J Asthma. 2025; 62:1472-82.

[26] Tashiro H, Kuwahara Y, Takahashi K. Gut—lung axis in asthma and obesity: role of the gut microbiome. Front Allergy. 2025; 6:1618466.

[27] Pakhale S, Baron J, Dent R, Vandemheen K, Aaron SD. Effects of weight loss on airway responsiveness in obese adults with asthma: does weight loss lead to reversibility of asthma? Chest. 2015; 147:1582-90.

[28] Aaron SD, Fergusson D, Dent R, Chen Y, Vandemheen KL, Dales RE. Effect of weight reduction on respiratory function and airway reactivity in obese women. Chest. 2004; 125:2046—52.

[29] Ait—Hadad W, Bédard A, Orsi L, Chanoine S, Dumas O, Laouali N, et al. Mediating role of the body mass index in the prospective association between a healthy diet and evolution of asthma symptoms in elderly women. JAR Life. 2025; 14:100011.

[30] Calder PC. n—3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr. 2006; 83:1505S-19S.

[31] Giudetti AM, Cagnazzo R. Beneficial effects of n—3 PUFA on chronic airway inflammatory diseases. Prostaglandins Other Lipid Mediat. 2012; 99:57-67.

[32] Papamichael MM, Katsardis C, Lambert K, Tsoukalas D, Koutsilieris M, Erbas B, et al. Efficacy of a Mediterranean diet supplemented with fatty fish in ameliorating inflammation in paediatric asthma: a randomised controlled trial. J Hum Nutr Diet. 2019; 32:185-97.

[33] Mekonnen TC, Shi Z, Gebremichael B, Melaku YA, Gill TK. Ultra—processed food consumption is linked to an increased risk of chronic respiratory diseases: A systematic review and meta—analysis of prospective cohort studies. Clin Nutr ESPEN. 2025; 68:647—59.

[34] Liu Y, Zhou Y, Zhang H, Zhao K, Yang D. Gut—lung Axis mediates asthma pathogenesis: Roles of dietary patterns and their impact on the gut microbiota. Exp Mol Pathol. 2025; 142:104964.

[35] Lee HS, Barraza—Villarreal A, Hernandez—Vargas H, Sly PD, Biessy C, Ramakrishnan U, et al. Modulation of DNA methylation states and infant immune system by dietary supplementation with ω—3 PUFA during pregnancy in an intervention study. Am J Clin Nutr. 2013; 98:480-7.

[36] Yu B, Pei C, Peng W, Zheng Y, Fu Y, Wang X, et al. Microbiota—derived butyrate alleviates asthma via inhibiting Tfh13—mediated IgE production. Signal Transduct Target Ther. 2025; 10:181.

[37] Maciag MC, Phipatanakul W. Prevention of Asthma: Targets for Intervention. Chest. 2020; 158:913—22.

[38] Talaei M, Sdona E, Calder PC, Jones LR, Emmett PM, Granell R, et al. Intake of n—3 polyunsaturated fatty acids in childhood, FADS genotype and incident asthma . Eur Respir J. 2021; 58:2003633.

[39] Chen CH, Wang YH, Lai CC, Wang CY, Wang HC. The impact of the eosinophil on the risk of acute exacerbation in asthma patients. BMJ Open Respir Res. 2025; 12:e003129.

[40] Zhang J, Wang B, Tang Z, He Y, He Y, An R, et al. Plant—based diets, genetic predisposition, and the risk of adult—onset asthma A prospective study. Eur J Nutr. 2025; 64:249.

[41] Cardet JC, Louisias M, King TS, Castro M, Codispoti CD, Dunn R, et al. ; Vitamin D Add—On Therapy Enhances Corticosteroid Disparities Working Group members on behalf of the AsthmaNet investigators. Income is an independent risk factor for worse asthma outcomes. J Allergy Clin Immunol. 2018; 141:754-60.e3.

[42] Riverin BD, Maguire JL, Li P. Vitamin D Supplementation for Childhood Asthma: A Systematic Review and Meta—Analysis. PLoS One. 2015; 10:e0136841.

[43] Özbey Ü, Balaban S, Sözener ZÇ, Uçar A, Mungan D, Mısırlıgil Z. The effects of diet—induced weight loss on asthma control and quality of life in obese adults with asthma: a randomized controlled trial. J Asthma. 2020; 57:618—26.

[44] Stenius—Aarniala B, Poussa T, Kvarnström J, Grönlund EL, Ylikahri M, Mustajoki P. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ. 2000; 320:827—32.

[45] Dionne V, Iglesies—Grau J, Latour É, Besnier F, Gagnon C, Gayda M. Optimizing cardiovascular health with a type 2 diabetes remission program: ultraprocessed food—intake reduction, Mediterranean diet, chrononutrition and physical training—The DIABEPIC—2 pilot study. Diabetes Obes Metab. 2025; 27:7374-84.

[46] Krebs JD, Parry—Strong A, Braakhuis A, Worthington A, Merry TL, Gearry RB, et al. A Mediterranean dietary pattern intervention does not improve cardiometabolic risk but does improve quality of life and body composition in an Aotearoa New Zealand population at increased cardiometabolic risk: A randomised controlled trial. Diabetes Obes Metab. 2025; 27:368-76.

[47] Widmer RJ, Flammer AJ, Lerman LO, Lerman A. The Mediterranean diet, its components, and cardiovascular disease. Am J Med. 2015; 128:229-38.

[48] Tan K, Sun N, Chen J, Long J, Feng W, Zhang X, et al. Adherence to the Mediterranean diet and allergic diseases in Korean adults: KNHANES 2013—2016. Front Nutr. 2025; 12:1563251.

[49] Sfika M, Kasdagli M, Naska A, Blizou M, Schoini P, Voulgareli I, et al. Adherence to Mediterranean diet and asthma control. Results from a small study among asthmatic patients in Greece. J Asthma. 2025; 62:541-7.

[50] Georgakou AV, Ekström S, Andersson N, Hallberg J, Wolk A, Håkansson N, et al. Mediterranean—type diet in school age in relation to asthma and lung function up to young adulthood. Clin Exp Allergy. 2024; 54:518—20.

[51] Poursoleiman F, Sasanfar B, Behniafard N, Nafei Z, Akbarian E, Khalili A, et al. Adherence to a modified Mediterranean diet and in association with asthma and wheezing in schoolchildren: A cross—sectional study. World Allergy Organ J. 2024; 17:100948.

[52] Ayats—Vidal R, Albiciuc I, Bruch—Molist C, Cuartero—Gorjón A, Cordobilla B, Pedrosa—Domínguez M, et al. Erythrocyte Fatty Acid Profile, Mediterranean Diet and Asthma Severity in Childhood Allergic Asthma: Preliminary Findings from a Cohort Study in Spain. Nutrients. 2025; 17:1161.

[53] Nagakura T, Matsuda S, Shichijyo K, Sugimoto H, Hata K. Dietary supplementation with fish oil rich in omega—3 polyunsaturated fatty acids in children with bronchial asthma. Eur Respir J. 2000; 16:861—5.

[54] Estruch R, Martínez—González MA, Corella D, Salas—Salvadó J, Ruiz—Gutiérrez V, Covas MI, et al. ; PREDIMED Study Investigators. Effects of a Mediterranean—style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145:1-11.

[55] Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim Care. 2002; 29:231-61.

[56] Ebden P, Bevan C, Banks J, Fennerty A, Walters EH. A study of evening primrose seed oil in atopic asthma. Prostaglandins Leukot Essent Fatty Acids. 1989; 35:69-72.

[57] Deepika C, Hankamer B, Ross IL. Can microalgal omega—3 PUFA production systems remain viable as GM plant sources emerge? Bioresour Technol. 2026; 441:133525.

[58] Kris—Etherton PM, Harris WS, Appel LJ ; American Heart Association. Nutrition Committee. Fish consumption, fish oil, omega—3 fatty acids, and cardiovascular disease. Circulation. 2002; 106:2747-57.

[59] Lundström SL, Yang J, Brannan JD, Haeggström JZ, Hammock BD, Nair P, et al. Lipid mediator serum profiles in asthmatics significantly shift following dietary supplementation with omega—3 fatty acids. Mol Nutr Food Res. 2013; 57:1378—89.

[60] Wenzel SE. The role of leukotrienes in asthma. Prostaglandins Leukot Essent Fatty Acids. 2003; 69:145—55.

[61] von Schacky C, Kiefl R, Jendraschak E, Kaminski WE. n—3 fatty acids and cysteinyl—leukotriene formation in humans in vitro, ex vivo, and in vivo. J Lab Clin Med. 1993; 121:302—9.

[62] Lang JE, Mougey EB, Hossain MJ, Livingston F, Balagopal PB, Langdon S, et al. Fish Oil Supplementation in Overweight/Obese Patients with Uncontrolled Asthma. A Randomized Trial. Ann Am Thorac Soc. 2019; 16:554-62.

[63] Mølsæter K, Roth K, Myklebust TÅ, Hermansen E, Singh D, Currie C, et al. The Efficacy of Daily Salmon Oil for Adult Type 2 Asthma: An Exploratory Randomized Double—Blind Trial. Mar Drugs. 2025; 23:328.

[64] Brannan JD, Bood J, Alkhabaz A, Balgoma D, Otis J, Delin I, et al. The effect of omega—3 fatty acids on bronchial hyperresponsiveness, sputum eosinophilia, and mast cell mediators in asthma. Chest. 2015; 147:397-405.

[65] Mickleborough TD, Vaughn CL, Shei R, Davis EM, Wilhite DP. Marine lipid fraction PCSO—524 (lyprinol/omega XL) of the New Zealand green lipped mussel attenuates hyperpnea—induced bronchoconstriction in asthma. Respir Med. 2013; 107:1152—63.

[66] Covar R, Gleason M, Macomber B, Stewart L, Szefler P, Engelhardt K, et al. Impact of a novel nutritional formula on asthma control and biomarkers of allergic airway inflammation in children. Clin Exp Allergy. 2010; 40:1163-74.

[67] Mickleborough TD, Lindley MR, Ionescu AA, Fly AD. Protective effect of fish oil supplementation on exercise—induced bronchoconstriction in asthma. Chest. 2006; 129:39-49.

[68] Mickleborough TD, Murray RL, Ionescu AA, Lindley MR. Fish oil supplementation reduces severity of exercise—induced bronchoconstriction in elite athletes. Am J Respir Crit Care Med. 2003; 168:1181—9.

[69] Dreßler M, Fussbroich D, Böhler L, Herrmann E, Benker N, Tytyk M, et al. Oil supplementation with a special combination of n—3 and n—6 long—chain polyunsaturated fatty acids does not protect for exercise induced asthma: a double—blind placebo—controlled trial. Lipids Health Dis. 2020; 19:167.

[70] Lindemann J, David Pampe E, Peterkin JJ, Orozco—Cronin P, Belofsky G, Stull D . Clinical study of the effects on asthma—related QOL and asthma management of a medical food in adult asthma patients. Curr Med Res Opin. 2009; 25:2865-75.

[71] Moreira A, Moreira P, Delgado L, Fonseca J, Teixeira V, Padrão P, et al. Pilot study of the effects of n—3 polyunsaturated fatty acids on exhaled nitric oxide in patients with stable asthma. J Investig Allergol Clin Immunol. 2007; 17:309—13.

[72] Surette ME, Stull D, Lindemann J. The impact of a medical food containing gammalinolenic and eicosapentaenoic acids on asthma management and the quality of life of adult asthma patients. Curr Med Res Opin. 2008; 24:559-67.

[73] Schubert R, Kitz R, Beermann C, Rose MA, Lieb A, Sommerer PC, et al. Effect of n—3 polyunsaturated fatty acids in asthma after low—dose allergen challenge. Int Arch Allergy Immunol. 2009; 148:321—9.

[74] Arm JP, Horton CE, Mencia—Huerta JM, House F, Eiser NM, Clark TJ, et al. Effect of dietary supplementation with fish oil lipids on mild asthma. Thorax. 1988; 43:84-92.

[75] Emelyanov A, Fedoseev G, Krasnoschekova O, Abulimity A, Trendeleva T, Barnes PJ. Treatment of asthma with lipid extract of New Zealand green—lipped mussel: a randomised clinical trial. Eur Respir J. 2002; 20:596-600.

[76] Okamoto M, Mitsunobu F, Ashida K, Mifune T, Hosaki Y, Tsugeno H, et al. Effects of dietary supplementation with n—3 fatty acids compared with n—6 fatty acids on bronchial asthma. Intern Med. 2000; 39:107—11.

[77] Hodge L, Salome CM, Hughes JM, Liu—Brennan D, Rimmer J, Allman M, et al. Effect of dietary intake of omega—3 and omega—6 fatty acids on severity of asthma in children. Eur Respir J. 1998; 11:361-5.

[78] Broughton KS, Johnson CS, Pace BK, Liebman M, Kleppinger KM. Reduced asthma symptoms with n—3 fatty acid ingestion are related to 5—series leukotriene production. Am J Clin Nutr. 1997; 65:1011-7.

[79] Thien FC, Mencia—Huerta JM, Lee TH. Dietary fish oil effects on seasonal hay fever and asthma in pollen—sensitive subjects. Am Rev Respir Dis. 1993; 147:1138-43.

[80] Hederos CA, Berg A. Epogam evening primrose oil treatment in atopic dermatitis and asthma. Arch Dis Child. 1996; 75:494—7.

[81] Kirsch CM, Payan DG, Wong MY, Dohlman JG, Blake VA, Petri MA, et al. Effect of eicosapentaenoic acid in asthma. Clin Allergy. 1988; 18:177-87.

[82] D’Vaz N, Meldrum SJ, Dunstan JA, Martino D, McCarthy S, Metcalfe J, et al. Postnatal fish oil supplementation in high—risk infants to prevent allergy: randomized controlled trial. Pediatrics. 2012; 130:674-82.

[83] Mihrshahi S, Peat JK, Webb K, Oddy W, Marks GB, Mellis CM ; CAPS Team. Effect of omega—3 fatty acid concentrations in plasma on symptoms of asthma at 18 months of age. Pediatr Allergy Immunol. 2004; 15:517—22.

[84] Peat JK, Mihrshahi S, Kemp AS, Marks GB, Tovey ER, Webb K, et al. Three—year outcomes of dietary fatty acid modification and house dust mite reduction in the Childhood Asthma Prevention Study. J Allergy Clin Immunol. 2004; 114:807-13.

[85] Marks GB, Mihrshahi S, Kemp AS, Tovey ER, Webb K, Almqvist C, et al. Prevention of asthma during the first 5 years of life: a randomized controlled trial. J Allergy Clin Immunol. 2006; 118:53-61.

[86] Almqvist C, Garden F, Xuan W, Mihrshahi S, Leeder SR, Oddy W, et al. CAPS team. Omega—3 and omega—6 fatty acid exposure from early life does not affect atopy and asthma at age 5 years. J Allergy Clin Immunol. 2007; 119:1438—44.

[87] Birch EE, Khoury JC, Berseth CL, Castañeda YS, Couch JM, Bean J, et al. The impact of early nutrition on incidence of allergic manifestations and common respiratory illnesses in children. J Pediatr. 2010; 156:902—6.e1.

[88] Garden FL, Toelle BG, Mihrshahi S, Webb KL, Almqvist C, Tovey ER, et al. Cohort profile: The Childhood Asthma Prevention Study (CAPS). Int J Epidemiol. 2018; 47:1736-k.

[89] Toelle BG, Ng KKW, Crisafulli D, Belousova EG, Almqvist C, Webb K, et al. Eight—year outcomes of the Childhood Asthma Prevention Study. J Allergy Clin Immunol. 2010; 126:388—9, 389.e1.

[90] Manley BJ, Makrides M, Collins CT, McPhee AJ, Gibson RA, Ryan P, et al. ; DINO Steering Committee. High—dose docosahexaenoic acid supplementation of preterm infants: respiratory and allergy outcomes. Pediatrics. 2011; 128:e71-7.

[91] Picado C, Castillo JA, Schinca N, Pujades M, Ordinas A, Coronas A, et al. Effects of a fish oil enriched diet on aspirin intolerant asthmatic patients: a pilot study. Thorax. 1988; 43:93—7.

[92] Bisgaard H, Mikkelsen M, Rasmussen MA, Sevelsted A, Schoos AM, Brustad N, et al. Atopic and non—atopic effects of fish oil supplementation during pregnancy. Thorax. 2023; 78:1168—74.

[93] Bisgaard H, Stokholm J, Chawes BL, Vissing NH, Bjarnadóttir E, Schoos AM, et al. Fish Oil—Derived Fatty Acids in Pregnancy and Wheeze and Asthma in Offspring. N Engl J Med. 2016; 375:2530—9.

[94] Hansen S, Strøm M, Maslova E, Dahl R, Hoffmann HJ, Rytter D, et al. Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring. J Allergy Clin Immunol. 2017; 139:104-11.e4.

[95] Olsen SF, Østerdal ML, Salvig JD, Mortensen LM, Rytter D, Secher NJ, et al. Fish oil intake compared with olive oil intake in late pregnancy and asthma in the offspring: 16 y of registry—based follow—up from a randomized controlled trial. Am J Clin Nutr. 2008; 88:167-75.

[96] Komulainen M, Saros L, Vahlberg T, Nermes M, Jartti T, Laitinen K. Maternal fish oil and/or probiotics intervention: Allergic diseases in children up to two years old. Pediatr Allergy Immunol. 2023; 34:e14004.

[97] Best KP, Sullivan T, Palmer D, Gold M, Kennedy DJ, Martin J, et al. Prenatal Fish Oil Supplementation and Allergy: 6—Year Follow—up of a Randomized Controlled Trial. Pediatrics. 2016; 137:e20154443.

[98] Palmer DJ, Sullivan T, Gold MS, Prescott SL, Heddle R, Gibson RA, et al. Randomized controlled trial of fish oil supplementation in pregnancy on childhood allergies. Allergy. 2013; 68:1370—6.

[99] Dunstan JA, Mori TA, Barden A, Beilin LJ, Taylor AL, Holt PG, et al. Fish oil supplementation in pregnancy modifies neonatal allergen—specific immune responses and clinical outcomes in infants at high risk of atopy: a randomized, controlled trial. J Allergy Clin Immunol. 2003; 112:1178—84.

[100] Backer V, Nepper—Christensen S, Porsbjerg C, Linstow ML, Reersted P ; Greenlandic Population Study. Respiratory symptoms in greenlanders living in Greenland and Denmark: a population—based study. Ann Allergy Asthma Immunol. 2004; 93:76-82.

[101] Horrobin DF. Low prevalences of coronary heart disease (CHD), psoriasis, asthma and rheumatoid arthritis in Eskimos: are they caused by high dietary intake of eicosapentaenoic acid (EPA), a genetic variation of essential fatty acid (EFA) metabolism or a combination of both? Med Hypotheses. 1987; 22:421—8.

[102] Wang Y, Huang S, Kuo H, Fan H, Moreira A, Papamichael MM, et al. N—3 fatty acid supplementation in asthma management: A systematic review and meta—analysis. Allergy. 2021; 76:3042-6.

[103] Fluge O, Omenaas E, Eide GE, Gulsvik A. Fish consumption and respiratory symptoms among young adults in a Norwegian community. Eur Respir J. 1998; 12:336-40.

[104] Huether KM, Lamb JM, Skelly J, Brigham E, McCormack MC, Bose S, et al. Omega—3 fatty acid intake potentiates bronchodilator response in patients with obesity and poorly controlled asthma. Respir Med. 2025; 243:108131.

[105] Brigham EP, Matsui EC, Appel LJ, Bull DA, Curtin—Brosnan J, Zhai S, et al. A pilot feeding study for adults with asthma: The healthy eating better breathing trial. PLoS One. 2017; 12:e0180068.

[106] Woods RK, Thien FC, Abramson MJ. Dietary marine fatty acids (fish oil) for asthma in adults and children. Cochrane Database Syst Rev. 2002; 3:CD001283.

[107] Li Y, Li Q, Cao Z, Wu J. The causal association of polyunsaturated fatty acids with allergic disease: A two—sample Mendelian randomization study. Front Nutr. 2022; 9:962787.

[108] Brigham EP, Woo H, McCormack M, Rice J, Koehler K, Vulcain T, et al. Omega—3 and Omega—6 Intake Modifies Asthma Severity and Response to Indoor Air Pollution in Children. Am J Respir Crit Care Med. 2019; 199:1478-86.

[109] Wang C, Wang L, Ding W, Zhao F, Hou G. Effect of polyunsaturated fatty acids intake on the occurrence of current asthma among children and adolescents exposed to tobacco smoke: NHANES 2007—2018. J Health Popul Nutr. 2024; 43:168.

[110] Visioli F, Poli A. Omega 6 fatty acids: helpful, harmless or harmful? Curr Opin Clin Nutr Metab Care. 2025; 28:114—20.

[111] DiNicolantonio JJ, O’Keefe J. The Importance of Maintaining a Low Omega—6/Omega—3 Ratio for Reducing the Risk of Autoimmune Diseases, Asthma, and Allergies. Mo Med. 2021; 118:453-9.

[112] Arm JP, Horton CE, Spur BW, Mencia—Huerta JM, Lee TH. The effects of dietary supplementation with fish oil lipids on the airways response to inhaled allergen in bronchial asthma. Am Rev Respir Dis. 1989; 139:1395-400.

[113] Szefler SJ, Phillips BR, Martinez FD, Chinchilli VM, Lemanske RF, Strunk RC, et al. Characterization of within—subject responses to fluticasone and montelukast in childhood asthma. J Allergy Clin Immunol. 2005; 115:233-42.

[114] Ramsden CE. Breathing Easier with Fish Oil — A New Approach to Preventing Asthma? N Engl J Med. 2016; 375:2596—8.

[115] Jia Y, Huang Y, Wang H, Jiang H. A dose—response meta—analysis of the association between the maternal omega—3 long—chain polyunsaturated fatty acids supplement and risk of asthma/wheeze in offspring. BMC Pediatr. 2022; 22:422.

[116] Henry CO, Allsopp PJ, Yeates AJ, Spence T, Conway MC, Mulhern MS, et al. Associations between maternal fish intake and polyunsaturated fatty acid status with childhood asthma in a high fish—eating population. Pediatr Allergy Immunol. 2025; 36:e70019.

[117] Ekström S, Sdona E, Klevebro S, Hallberg J, Georgelis A, Kull I, et al. Dietary intake and plasma concentrations of PUFAs in childhood and adolescence in relation to asthma and lung function up to adulthood. Am J Clin Nutr. 2022; 115:886-96.

[118] Morris A, Noakes M, Clifton PM. The role of n—6 polyunsaturated fat in stable asthmatics. J Asthma. 2001; 38:311-9.

[119] Rosa MJ, Hartman TJ, Adgent M, Gardner K, Gebretsadik T, Moore PE, et al. Prenatal polyunsaturated fatty acids and child asthma: effect modification by maternal asthma and child sex. J Allergy Clin Immunol. 2020; 145:800-7.

[120] Cojic M, Kocic R, Klisic A, Kocic G. The Effects of Vitamin D Supplementation on Metabolic and Oxidative Stress Markers in Patients With Type 2 Diabetes: A 6—Month Follow Up Randomized Controlled Study. Front Endocrinol (Lausanne). 2021; 12:610893.

[121] Wu AC, Tantisira K, Li L, Fuhlbrigge AL, Weiss ST, Litonjua A, et al. ; Childhood Asthma Management Program Research Group. Effect of vitamin D and inhaled corticosteroid treatment on lung function in children. Am J Respir Crit Care Med. 2012; 186:508—13.

[122] Lu M, Litonjua AA, O’Connor GT, Zeiger RS, Bacharier L, Schatz M, et al. Effect of early and late prenatal vitamin D and maternal asthma status on offspring asthma or recurrent wheeze. J Allergy Clin Immunol. 2021; 147:1234-41.e3.

[123] Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, Strunk RC, Zeiger RS, et al. ; Childhood Asthma Management Program Research Group. Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol. 2010; 126:52-8.e5.

[124] Wu X, Zhan X, Ouyang C. Exploring the causal relationship between 25—hydroxyvitamin D and asthma: A bidirectional Mendelian randomization study. Medicine (Baltimore). 2025; 104:e44249.

[125] Watkins S, Harrison T, Mushtaq S. A 12—week double—blind randomised controlled trial investigating the effect of dietary supplementation with 125 μg/d vitamin D in adults with asthma . Br J Nutr. 2024; 132:738-49.

[126] O’Sullivan B, Ounpraseuth S, James L, Majure M, Lang J, Hu Z, et al. Vitamin D Oral Replacement in Children With Obesity Related Asthma: VDORA1 Randomized Clinical Trial. Clin Pharmacol Ther. 2024; 115:231-8.

[127] Nasantogtokh E, Ganmaa D, Altantuya S, Amgalan B, Enkhmaa D. Maternal vitamin D intakes during pregnancy and child health outcome. J Steroid Biochem Mol Biol. 2023; 235:106411.

[128] Shadid IL, Brustad N, Lu M, Chawes BL, Bisgaard H, Zeiger RS. The impact of baseline 25—hydroxyvitamin D level and gestational age on prenatal vitamin D supplementation to prevent offspring asthma or recurrent wheezing. Am J Clin Nutr. 2023; 117:1342—52.

[129] Camargo CA Jr, Toop L, Sluyter J, Lawes CMM, Waayer D, Khaw K, et al. Effect of Monthly Vitamin D Supplementation on Preventing Exacerbations of Asthma or Chronic Obstructive Pulmonary Disease in Older Adults: Post Hoc Analysis of a Randomized Controlled Trial. Nutrients. 2021; 13:521.

[130] Thakur C, Kumar J, Kumar P, Goyal JP, Singh K, Gupta A. Vitamin—D supplementation as an adjunct to standard treatment of asthma in children: A randomized controlled trial (ViDASTA Trial). Pediatr Pulmonol. 2021; 56:1427—33.

[131] Jat KR, Goel N, Gupta N, Gupta CP, Datta S, Lodha R, et al. Efficacy of vitamin D supplementation in asthmatic children with vitamin D deficiency: A randomized controlled trial (ESDAC trial). Pediatr Allergy Immunol. 2021; 32:479-88.

[132] Andújar—Espinosa R, Aparicio—Vicente M, Ruiz—López FJ, Salinero—González L. Influence of vitamin D supplementation on the quality of life of asthma patients: Findings from ACVID randomised clinical trial. Respir Med. 2021; 185:106484.

[133] Andújar—Espinosa R, Salinero—González L, Illán—Gómez F, Castilla—Martínez M, Hu—Yang C, Ruiz—López FJ. Effect of vitamin D supplementation on asthma control in patients with vitamin D deficiency: the ACVID randomised clinical trial. Thorax. 2021; 76:126-33.

[134] Forno E, Bacharier LB, Phipatanakul W, Guilbert TW, Cabana MD, Ross K, et al. Effect of Vitamin D3 Supplementation on Severe Asthma Exacerbations in Children With Asthma and Low Vitamin D Levels: The VDKA Randomized Clinical Trial. JAMA. 2020; 324:752-60.

[135] Rueter K, Jones AP, Siafarikas A, Lim E, Prescott SL, Palmer DJ. In “High—Risk” Infants with Sufficient Vitamin D Status at Birth, Infant Vitamin D Supplementation Had No Effect on Allergy Outcomes: A Randomized Controlled Trial. Nutrients. 2020; 12:1747.

[136] Litonjua AA, Carey VJ, Laranjo N, Stubbs BJ, Mirzakhani H, O’Connor GT, et al. Six—Year Follow—up of a Trial of Antenatal Vitamin D for Asthma Reduction. N Engl J Med. 2020; 382:525—33.

[137] Swangtrakul N, Manuyakorn W, Mahachoklertwattana P, Kiewngam P, Sasisakulporn C, Jotikasthirapa W, et al. Effect of vitamin D on lung function assessed by forced oscillation technique in asthmatic children with vitamin D deficiency: A randomized double—blind placebo—controlled trial. Asian Pac J Allergy Immunol. 2022; 40:22-30.

[138] Shabana MA, Esawy MM, Ismail NA, Said AM. Predictive role of IL—17A/IL—10 ratio in persistent asthmatic patients on vitamin D supplement. Immunobiology. 2019; 224:721—7.

[139] Brustad N, Eliasen AU, Stokholm J, Bønnelykke K, Bisgaard H, Chawes BL. High—Dose Vitamin D Supplementation During Pregnancy and Asthma in Offspring at the Age of 6 Years. JAMA. 2019; 321:1003-5.

[140] Ali AM, Selim S, Abbassi MM, Sabry NA. Effect of alfacalcidol on the pulmonary function of adult asthmatic patients: A randomized trial. Ann Allergy Asthma Immunol. 2017; 118:557-63.

[141] Grant CC, Crane J, Mitchell EA, Sinclair J, Stewart A, Milne T, et al. Vitamin D supplementation during pregnancy and infancy reduces aeroallergen sensitization: a randomized controlled trial. Allergy. 2016; 71:1325—34.

[142] Kerley CP, Hutchinson K, Cormican L, Faul J, Greally P, Coghlan D, et al. Vitamin D3 for uncontrolled childhood asthma: A pilot study. Pediatr Allergy Immunol. 2016; 27:404—12.

[143] Tachimoto H, Mezawa H, Segawa T, Akiyama N, Ida H, Urashima M. Improved control of childhood asthma with low—dose, short—term vitamin D supplementation: a randomized, double—blind, placebo—controlled trial. Allergy. 2016; 71:1001-9.

[144] Litonjua AA, Carey VJ, Laranjo N, Harshfield BJ, McElrath TF, O’Connor GT, et al. Effect of Prenatal Supplementation With Vitamin D on Asthma or Recurrent Wheezing in Offspring by Age 3 Years: The VDAART Randomized Clinical Trial. JAMA. 2016; 315:362-70.

[145] Chawes BL, Bønnelykke K, Stokholm J, Vissing NH, Bjarnadóttir E, Schoos AM, et al. Effect of Vitamin D3 Supplementation During Pregnancy on Risk of Persistent Wheeze in the Offspring: A Randomized Clinical Trial. JAMA. 2016; 315:353-61.

[146] Martineau AR, MacLaughlin BD, Hooper RL, Barnes NC, Jolliffe DA, Greiller CL, et al. Double—blind randomised placebo—controlled trial of bolus—dose vitamin D3 supplementation in adults with asthma (ViDiAs). Thorax. 2015; 70:451—7.

[147] Arshi S, Fallahpour M, Nabavi M, Bemanian MH, Javad—Mousavi SA, Nojomi M, et al. The effects of vitamin D supplementation on airway functions in mild to moderate persistent asthma. Ann Allergy Asthma Immunol. 2014; 113:404-9.

[148] Bar Yoseph R, Livnat G, Schnapp Z, Hakim F, Dabbah H, Goldbart A, et al. The effect of vitamin D on airway reactivity and inflammation in asthmatic children: A double—blind placebo—controlled trial. Pediatr Pulmonol. 2015; 50:747—53.

[149] Castro M, King TS, Kunselman SJ, Cabana MD, Denlinger L, Holguin F, et al. National Heart, Lung, and Blood Institute’s AsthmaNet. Effect of vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower vitamin D levels: the VIDA randomized clinical trial. JAMA. 2014; 311:2083—91.

[150] Yadav M, Mittal K. Effect of vitamin D supplementation on moderate to severe bronchial asthma. Indian J Pediatr. 2014; 81:650—4.

[151] Majak P, Olszowiec—Chlebna M, Smejda K, Stelmach I. Vitamin D supplementation in children may prevent asthma exacerbation triggered by acute respiratory infection. J Allergy Clin Immunol. 2011; 127:1294-6.

[152] de Groot JC, van Roon EN, Storm H, Veeger NJ, Zwinderman AH, Hiemstra PS, et al. Vitamin D reduces eosinophilic airway inflammation in nonatopic asthma. J Allergy Clin Immunol. 2015; 135:670—5.e3.

[153] Baris S, Kiykim A, Ozen A, Tulunay A, Karakoc—Aydiner E, Barlan IB. Vitamin D as an adjunct to subcutaneous allergen immunotherapy in asthmatic children sensitized to house dust mite. Allergy. 2014; 69:246—53.

[154] Gold DR, Carey VJ, Hersh CP, Wan E, Camargo CA Jr, Lee IM, et al. Vitamin D Supplementation, Chronic Obstructive Lung Disease and Asthma Exacerbations, and Lung Function Decline. J Nutr. 2025; 155:1417—28.

[155] Fedora K, Setyoningrum RA, Aina Q, Rosyidah LN, Ni’mah NL, Titiharja FF . Vitamin D supplementation decrease asthma exacerbations in children: a systematic review and meta—analysis of randomized controlled trials. Ann Med. 2024; 56:2400313.

[156] Beckhaus AA, Garcia—Marcos L, Forno E, Pacheco—Gonzalez RM, Celedón JC, Castro—Rodriguez JA. Maternal nutrition during pregnancy and risk of asthma, wheeze, and atopic diseases during childhood: a systematic review and meta—analysis. Allergy. 2015; 70:1588-604.

[157] Wei Z, Zhang J, Yu X. Maternal vitamin D status and childhood asthma, wheeze, and eczema: A systematic review and meta—analysis. Pediatr Allergy Immunol. 2016; 27:612-9.

[158] Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy: systematic review and meta—analysis. J Allergy Clin Immunol. 2011; 127:724-33.e1.

[159] Luo J, Liu D, Liu C—T. Can vitamin D supplementation in addition to asthma controllers improve clinical outcomes in patients with asthma? A meta—analysis. Medicine. 2015; 94:e2185.

[160] Jolliffe DA, Greenberg L, Hooper RL, Griffiths CJ, Camargo CA Jr, Kerley CP, et al. Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta—analysis of individual participant data. Lancet Respir Med. 2017; 5:881-90.

[161] Martineau AR, Cates CJ, Urashima M, Jensen M, Griffiths AP, Nurmatov U, et al. Vitamin D for the management of asthma. Cochrane Database Syst Rev. 2016; 9:CD011511.

[162] Brustad N, Greve JH, Mirzakhani H, Pedersen CT, Eliasen AU, Stokholm J, et al. High—dose vitamin D during pregnancy and pathway gene polymorphisms in prevention of offspring persistent wheeze. Pediatr Allergy Immunol. 2021; 32:679-89.

[163] Patchen BK, Best CM, Boiteau J, Solvik BS, Vonderschmidt A, Xu J, et al. Vitamin D supplementation in pregnant or breastfeeding women or young children for preventing asthma. Cochrane Database Syst Rev. 2025; 8:CD013396.

[164] Williamson A, Martineau AR, Sheikh A, Jolliffe D, Griffiths CJ. Vitamin D for the management of asthma. Cochrane Database Syst Rev. 2023; 2:CD011511.

[165] Martineau AR, Jolliffe DA, Greenberg L, Aloia JF, Bergman P, Dubnov—Raz G, et al. Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta—analysis. Health Technol Assess. 2019; 23:1-44.

[166] Jolliffe DA, Camargo CA Jr, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, et al. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta—analysis of aggregate data from randomised controlled trials. Lancet Diabetes Endocrinol. 2021; 9:276-92.

[167] Murphy VE, Jensen ME, Harvey S, Beyene T, Gregson J, Islam F, et al. Vitamin A, C and/or E Intake During Pregnancy and Offspring Respiratory Health: A Systematic Review and Meta—Analysis. J Hum Nutr Diet. 2025; 38:e70086.

[168] García—García C, Kim M, Baik I. Associations of dietary vitamin A and C intake with asthma, allergic rhinitis, and allergic respiratory diseases. Nutr Res Pract. 2023; 17:997-1006.

[169] Songnuy T, Ninla—Aesong P, Thairach P, Thok—Ngaen J. Effectiveness of an antioxidant—rich diet on childhood asthma outcomes: A randomized controlled trial. BMC Nutr. 2025; 11:89.

[170] Tian Z, Li X, Han Y, Zhang X. The association between the composite dietary antioxidant index and asthma in US children aged 3—18 years: a cross—sectional study from NHANES. Sci Rep. 2024; 14:17204.

[171] Zhou X, Zhou Y, Chen J, Chen C, Chen R, Zheng S, et al. Dietary antioxidants: a challenge or an opportunity for asthma? Genetic insights from a Two—sample mendelian randomization study. J Asthma. 2025; 62:2094-104.

[172] McEvoy CT, Schilling D, Clay N, Jackson K, Go MD, Spitale P, et al. Vitamin C supplementation for pregnant smoking women and pulmonary function in their newborn infants: a randomized clinical trial. JAMA. 2014; 311:2074-82.

[173] Vahdaninia M, Mackenzie H, Helps S, Dean T. Prenatal Intake of Vitamins and Allergic Outcomes in the Offspring: A Systematic Review and Meta—Analysis. J Allergy Clin Immunol Pract. 2017; 5:771-8.e5.

[174] West CE, Dunstan J, McCarthy S, Metcalfe J, D’Vaz N, Meldrum S, et al. Associations between maternal antioxidant intakes in pregnancy and infant allergic outcomes. Nutrients. 2012; 4:1747-58.

[175] Gao J, Gao X, Li W, Zhu Y, Thompson PJ. Observational studies on the effect of dietary antioxidants on asthma: a meta—analysis. Respirology. 2008; 13:528—36.

[176] Allen S, Britton JR, Leonardi—Bee JA. Association between antioxidant vitamins and asthma outcome measures: systematic review and meta—analysis. Thorax. 2009; 64:610—9.

[177] Wu H, Zhang C, Wang Y, Li Y. Does vitamin E prevent asthma or wheeze in children: A systematic review and meta—analysis. Paediatr Respir Rev. 2018; 27:60-8.

[178] Martindale S, McNeill G, Devereux G, Campbell D, Russell G, Seaton A. Antioxidant intake in pregnancy in relation to wheeze and eczema in the first two years of life. Am J Respir Crit Care Med. 2005; 171:121—8.

[179] Turner SW, Campbell D, Smith N, Craig LCA, McNeill G, Forbes SH, et al. Associations between fetal size, maternal {alpha}—tocopherol and childhood asthma. Thorax. 2010; 65:391-7.

[180] Greenough A, Shaheen SO, Shennan A, Seed PT, Poston L. Respiratory outcomes in early childhood following antenatal vitamin C and E supplementation. Thorax. 2010; 65:998-1003.

[181] Maslova E, Hansen S, Strøm M, Halldorsson TI, Olsen SF. Maternal intake of vitamins A, E and K in pregnancy and child allergic disease: a longitudinal study from the Danish National Birth Cohort. Br J Nutr. 2014; 111:1096-108.

[182] Lyu J, Li H, Zhang H. Revealing the Association Between Total and Subclass Flavonoid Intakes and the Prevalence of Asthma in U.S. Adults. Food Sci Nutr. 2025; 13:e71063.

[183] Tanaka T, Takahashi R. Flavonoids and asthma. Nutrients. 2013; 5:2128-43.

[184] Lau BH, Riesen SK, Truong KP, Lau EW, Rohdewald P, Barreta RA. Pycnogenol as an adjunct in the management of childhood asthma. J Asthma. 2004; 41:825—32.

[185] Schoonees A, Visser J, Musekiwa A, Volmink J. Pycnogenol^® (extract of French maritime pine bark) for the treatment of chronic disorders . Cochrane Database Syst Rev. 2012; 4:CD008294.

[186] Pan J, Zhang Y, Qiu S, Peng S, Kang H, Tung T, et al. Gut microbiome dysbiosis in chronic lung disease: a systematic review and meta—analysis. Front Cell Infect Microbiol. 2025; 15:1554846.

[187] Fan D, Hu J, Lin N. Effects of probiotics, prebiotics, synbiotics and postbiotics on pediatric asthma: a systematic review. Front Nutr. 2025; 12:1586129.

[188] Liu Y, Zhang Y, Li Y, Zhang X, Xie L, Liu H. Probiotics for children with asthma: a systematic review and meta—analysis. Front Pediatr. 2025; 13:1577152.

[189] Xie Q, Yuan J, Wang Y. Treating asthma patients with probiotics: a systematic review and meta—analysis. Nutr Hosp. 2023; 40:829—38.

[190] Du X, Wang L, Wu S, Yuan L, Tang S, Xiang Y, et al. Efficacy of probiotic supplementary therapy for asthma, allergic rhinitis, and wheeze: a meta—analysis of randomized controlled trials. Allergy Asthma Proc. 2019; 40:250-60.

[191] Wang HZ, Hayles EH, Fiander M, Sinn JK, Osborn DA. Probiotics in infants for prevention of allergic disease. Cochrane Database Syst Rev. 2025; 6:CD006475.

[192] Burney P. A diet rich in sodium may potentiate asthma. Epidemiologic evidence for a new hypothesis. Chest. 1987; 91:143S-8S.

[193] Burney PG, Britton JR, Chinn S, Tattersfield AE, Platt HS, Papacosta AO, et al. Response to inhaled histamine and 24 hour sodium excretion. Br Med J (Clin Res Ed). 1986; 292:1483—6.

[194] Knox AJ. Salt and asthma. BMJ. 1993; 307:1159-60.

[195] Mickleborough TD, Lindley MR, Ray S. Dietary salt, airway inflammation, and diffusion capacity in exercise—induced asthma. Med Sci Sports Exerc. 2005; 37:904-14.

[196] Gotshall RW, Mickleborough TD, Cordain L. Dietary salt restriction improves pulmonary function in exercise—induced asthma. Med Sci Sports Exerc. 2000; 32:1815—9.

[197] Ardern KD. Dietary salt reduction or exclusion for allergic asthma. Cochrane Database Syst Rev. 2004; 3:CD000436.

[198] Pogson Z, McKeever T. Dietary sodium manipulation and asthma. Cochrane Database Syst Rev. 2011; 2011:CD000436.

[199] Silva IS, Fregonezi GAF, Dias FAL, Ribeiro CTD, Guerra RO, Ferreira GMH. Inspiratory muscle training for asthma. Cochrane Database Syst Rev. 2013; 2013:CD003792.

[200] Lista—Paz A, Bouza Cousillas L, Jácome C, Fregonezi G, Labata—Lezaun N, Llurda—Almuzara L, et al. Effect of respiratory muscle training in asthma: A systematic review and meta—analysis. Ann Phys Rehabil Med. 2023; 66:101691.

[201] Santino TA, Chaves GS, Freitas DA, Fregonezi GA, Mendonça KM. Breathing exercises for adults with asthma. Cochrane Database Syst Rev. 2020; 3:CD001277.

[202] Carson KV, Chandratilleke MG, Picot J, Brinn MP, Esterman AJ, Smith BJ. Physical training for asthma. Cochrane Database Syst Rev. 2013; 2013:CD001116.

[203] O’Neill C, Dogra S. Reducing Anxiety and Anxiety Sensitivity With High—Intensity Interval Training in Adults With Asthma. J Phys Act Health. 2020; 17:835-9.

[204] Hansen ESH, Pitzner—Fabricius A, Toennesen LL, Rasmusen HK, Hostrup M, Hellsten Y, et al. Effect of aerobic exercise training on asthma in adults: a systematic review and meta—analysis. Eur Respir J. 2020; 56:2000146.

[205] Pitzner—Fabricius A, Dall CH, Henriksen M, Hansen ESH, Toennesen LL, Hostrup M, et al. Effect of High—Intensity Interval Training on Inhaled Corticosteroid Dose in Asthma Patients: A Randomized Controlled Trial. J Allergy Clin Immunol Pract. 2023; 11:2133-43.e8.

[206] Anshu, Singh N, Deka S, Saraswati P, Sindhwani G, Goel A, et al. The effect of yoga on pulmonary function in patients with asthma: A meta—analysis. Complement Ther Clin Pract. 2023; 50:101682.

[207] Cramer H, Posadzki P, Dobos G, Langhorst J. Yoga for asthma: a systematic review and meta—analysis. Ann Allergy Asthma Immunol. 2014; 112:503-10.e5.

[208] Yang Z, Zhong H, Mao C, Yuan J, Huang Y, Wu X, et al. Yoga for asthma. Cochrane Database Syst Rev. 2016; 4:CD010346.

[209] Yadav A, Singh N, Deka S, Sindhwani G. Enhancing Asthma Management: The Impact of Online Holistic Yoga on Symptom Relief and Lung Function in Mild to Moderate Asthma Patients: A Pilot Study. Adv Mind Body Med. 2025; 39:10-5.

[210] Türk Y, Theel W, van Huisstede A, van de Geijn GM, Birnie E, Hiemstra PS, et al. Short—term and long—term effect of a high—intensity pulmonary rehabilitation programme in obese patients with asthma: a randomised controlled trial. Eur Respir J. 2020; 56:1901820.

[211] Ricketts HC, Sharma V, Steffensen F, Goodfellow A, Mackay E, MacDonald G, et al. A pragmatic randomised controlled trial of tailored pulmonary rehabilitation in participants with difficult—to—control asthma and elevated body mass index. BMC Pulm Med. 2022; 22:363.

[212] Zampogna E, Oliva FM, Del Furia MJ, Cordani C, Lazzarini SG, Arienti C. Effectiveness of Rehabilitation Interventions in Adults With Asthma: A Systematic Review and Meta—analysis. Am J Phys Med Rehabil. 2025; 104:e28-36.

[213] Aaron SD, Vandemheen KL, FitzGerald JM, Ainslie M, Gupta S, Lemière C, et al. Canadian Respiratory Research Network. Reevaluation of Diagnosis in Adults With Physician—Diagnosed Asthma. JAMA. 2017; 317:269-79.

[214] Sedgwick P. Multiple hypothesis testing and Bonferroni’s correction. BMJ. 2014; 349:g6284.

[215] de Lima FF, Dos Santos JMB, Lunardi AC, de Oliveira JM, Freitas PD, Kim FS, et al. Physical Activity and Sedentary Behavior as Treatable Traits for Clinical Control in Moderate—to—Severe Asthma. J Allergy Clin Immunol Pract. 2024; 12:2047—55.

[216] Xing S, Feng S, Zeng D. Effect of exercise intervention on lung function in asthmatic adults: a network meta—analysis. Ann Med. 2023; 55:2237031.