Effects of probiotics, prebiotics, synbiotics and postbiotics on pediatric asthma: a systematic review

Fan, Die; Hu, Jilei; Lin, Ning

doi:10.3389/fnut.2025.1586129

SYSTEMATIC REVIEW article

Front. Nutr.

Sec. Nutrition and Microbes

Volume 12 - 2025 | doi: 10.3389/fnut.2025.1586129

This article is part of the Research Topic Strain-Specific Probiotics: Enhancing Children's Health Through Targeted Clinical Research View all 8 articles

Effects of probiotics, prebiotics, synbiotics and postbiotics on pediatric asthma: a systematic review

Provisionally accepted

Die Fan

Jilei Hu

Ning Lin ^*

Western Theater General Hospital, Chengdu, China

The final, formatted version of the article will be published soon.

Background Pediatric asthma, a prevalent chronic disease with rising global incidence, imposing substantial healthcare and socioeconomic burdens. Emerging evidence highlights the gut-lung axis as a pivotal therapeutic target, with microbiota dysbiosis implicated in immune dysregulation and airway hyperresponsiveness. This systematic review evaluated the efficacy and safety of probiotics, prebiotics, synbiotics, and postbiotics in pediatric asthma management. Methods A comprehensive search of PubMed, Cochrane library, Web of Science, and Embase was conducted up to 2 nd January 2025. Inclusion criteria encompassed randomized controlled trials (RCTs) evaluating the therapeutic use of probiotics, prebiotics, synbiotics, or postbiotics in children and/or adolescents (<18 years) with asthma. Results 18 studies (13 RCTs, n = 2,419 participants) were analyzed, focusing on children aged < 18 years. Probiotic interventions, predominantly Lactobacillus (5 studies) and Bifidobacterium (5 studies), demonstrated significant reductions in asthma exacerbations and improved pulmonary function, with strain-specific effects linked to Th2 cytokine suppression and gut-lung axis modulation. Postbiotics, including bacterial lysates (OM-85 BV, PMBL®), attenuated airway hyperresponsiveness and systemic inflammation. Synbiotics reduced viral respiratory infections and healthcare utilization. However, there is still a lack of direct RCTs to explore the therapeutic effects of prebiotics on pediatric asthma. Key limitations include methodological heterogeneity (dosing: 10⁸-10¹⁰ CFU/day; duration: 8 weeks-12 months) and risk of bias (3 low-risk, 12 with concerns). Conclusion Our findings underscored the potential of microbiota-targeted therapies but highlight the need for standardized protocols, strain-specific trials, and pediatric prebiotic research. Future studies should integrate multi-omics to elucidate mechanisms and optimize personalized interventions.

Keywords: pediatric asthma, Probiotics, Prebiotics, Synbiotics, Postbiotics, Systematic review

Received: 02 Mar 2025; Accepted: 07 Apr 2025.

Copyright: © 2025 Fan, Hu and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ning Lin, Western Theater General Hospital, Chengdu, China

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