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

2025-04-25
Frontiers in nutrition 12
- Die Fan
- Jilei Hu
- Ning Lin

PubMed: 40352259
DOI: 10.3389/fnut.2025.1586129

Study Design

Type: Systematic Review
Sample size: n = 419
Population: children and/or adolescents (<18 years) with asthma
Methods: A comprehensive search of PubMed, Cochrane library, Web of Science, and Embase was conducted up to 2nd 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

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 2nd 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

Eighteen 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.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42025641318, identifier: CRD42025641318.

Research Insights

Bifidobacterium→Improved Pulmonary Function
Probiotic interventions, predominantly... Bifidobacterium (5 studies)... improved pulmonary function
Effect
Beneficial
Effect size
Moderate
Dose
10^8-10^10 CFU/day
Bifidobacterium→Reduced Asthma Exacerbation
Probiotic interventions, predominantly... Bifidobacterium (5 studies), demonstrated significant reductions in asthma exacerbations
Effect
Beneficial
Effect size
Moderate
Dose
10^8-10^10 CFU/day
Bifidobacterium→Reduced Asthma Exacerbations
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.
Effect
Beneficial
Effect size
Moderate
Dose
10^8-10^10 CFU/day
Lactobacillus→Improved Pulmonary Function
Probiotic interventions, predominantly... Bifidobacterium (5 studies)... improved pulmonary function
Effect
Beneficial
Effect size
Moderate
Dose
10^8-10^10 CFU/day
Lactobacillus→Reduced Asthma Exacerbation
Probiotic interventions, predominantly... Bifidobacterium (5 studies), demonstrated significant reductions in asthma exacerbations
Effect
Beneficial
Effect size
Moderate
Dose
10^8-10^10 CFU/day
Lactobacillus→Reduced Asthma Exacerbations
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.
Effect
Beneficial
Effect size
Moderate
Dose
10^8-10^10 CFU/day
Lactobacillus rhamnosus→Improved Pulmonary Function
Probiotic interventions, predominantly... Bifidobacterium (5 studies)... improved pulmonary function
Effect
Beneficial
Effect size
Moderate
Dose
10^8-10^10 CFU/day
Lactobacillus rhamnosus→Reduced Airway Hyperresponsiveness
Postbiotics, including bacterial lysates (OM-85 BV, PMBL®), attenuated airway hyperresponsiveness and systemic inflammation.
Effect
Beneficial
Effect size
Moderate
Lactobacillus rhamnosus→Reduced Asthma Exacerbations
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.
Effect
Beneficial
Effect size
Moderate
Dose
10^8-10^10 CFU/day
Lactobacillus rhamnosus→Reduced Healthcare Costs
Synbiotics reduced viral respiratory infections and healthcare utilization.
Effect
Beneficial
Effect size
Small
Lactobacillus rhamnosus→Reduced Inflammation
Postbiotics, including bacterial lysates (OM-85 BV, PMBL®), attenuated airway hyperresponsiveness and systemic inflammation.
Effect
Beneficial
Effect size
Moderate
Lactobacillus rhamnosus→Reduced Viral Respiratory Infection
Synbiotics reduced viral respiratory infections and healthcare utilization.
Effect
Beneficial
Effect size
Small