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.