Natural medicines for asthma management: mechanisms aligned with endotypes and multi-dimensional intervention

Background Asthma is a heterogeneous chronic inflammatory airway disease affecting over 300 million people globally. Inhaled corticosteroids remain first-line therapy but cause adverse effects and fail to address core pathologies in 5%–10% of patients—particularly those with Type 2-low endotypes exhibiting glucocorticoid resistance. Natural medicines, with multi-component synergy, offer a promising strategy to bridge this gap. Objective This review synthesizes advances in botanical extracts and bioactive constituents for asthma management, focusing on pharmacological mechanisms aligned with asthma endotypes. Methods A literature search across PubMed and Web of Science (2010–2026) included preclinical studies and randomized controlled trials (RCTs). Therapeutic effects were categorized into anti-inflammation, antioxidant modulation, immunoregulation, and anti-remodeling. Results Botanical therapeutics concurrently restore epithelial barrier integrity, rebalance Th1/Th2/Th17 immunity, activate Nrf2-mediated antioxidant pathways, and inhibit airway remodeling. RCTs demonstrate adjunctive benefits in mild-to-moderate asthma; however, translational bottlenecks persist, including phytochemical bioavailability issues and insufficient biomarker-stratified data. Conclusion Natural medicines overcome limitations of single-target synthetic drugs via multi-dimensional intervention. Clinical translation necessitates standardized formulations, advanced pulmonary delivery systems, rigorous safety evaluations—including herb-drug interactions—and endotype-stratified RCTs.