Nutritional Interventions to Improve Asthma-Related Outcomes through Immunomodulation: A Systematic Review.

Nutrients. 2020;12(12)
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Asthma is a chronic inflammatory disease of the airways, with the infiltration of immune cells into the airways leading to localized inflammation and asthmatic symptoms. This review sought to establish whether nutritional interventions can help improve asthma and if this happens via regulation of the immune system. 28 studies were included that investigated the impact on both asthma and immunological parameters. The interventions include herbs (Nigella sativa, Crocus sativa, Boswellia serrata gum, Aegle marmelos), supplements (Vitamin E, soy isoflavones, tomato extract), weight loss and reduced-calorie diets, Vitamin D3, omega-3 fatty acids and whole-food approaches such as the Mediterranean diet. Half of the studies reported improvements in either asthma symptoms or immunological parameters. Two studies showed worsening. The herbal mixtures had the most consistent impact in both areas, followed by omega-3 fatty acids. Of interest here was that low to moderate dosages seemingly obtained wider-ranging improvements than higher dosages. The least evidence was found for vitamin D in the studies included. Overall only a couple of studies showed clinically relevant improvements and the authors insist that more research is needed before further nutritional interventions can be included in guidelines for asthma management. According to this review, the evidence for nutritional evidence for asthma management is still limited, in particular for those interventions where symptoms improvements correlate with beneficial immunological changes.


Asthma is a chronic inflammatory disease of the airways, characterized by T-helper (Th) 2 inflammation. Current lifestyle recommendations for asthma patients are to consume a diet high in fruits and vegetables and to maintain a healthy weight. This raises the question of whether other nutritional interventions may also improve asthma-related outcomes and whether these changes occur via immunomodulation. Therefore, we systematically reviewed studies that reported both asthma-related outcomes as well as immunological parameters and searched for relations between these two domains. A systematic search identified 808 studies, of which 28 studies met the inclusion criteria. These studies were divided over six nutritional clusters: herbs, herbal mixtures and extracts (N = 6); supplements (N = 4); weight loss (N = 3); vitamin D3 (N = 5); omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) (N = 5); and whole-food approaches (N = 5). Fifteen studies reported improvements in either asthma-related outcomes or immunological parameters, of which eight studies reported simultaneous improvements in both domains. Two studies reported worsening in either asthma-related outcomes or immunological parameters, of which one study reported a worsening in both domains. Promising interventions used herbs, herbal mixtures or extracts, and omega-3 LCPUFAs, although limited interventions resulted in clinically relevant results. Future studies should focus on further optimizing the beneficial effects of nutritional interventions in asthma patients, e.g., by considering the phenotypes and endotypes of asthma.

Lifestyle medicine

Fundamental Clinical Imbalances : Immune and inflammation
Patient Centred Factors : Mediators/Nutrition immunomodulation
Environmental Inputs : Diet ; Nutrients
Personal Lifestyle Factors : Nutrition
Functional Laboratory Testing : Not applicable

Methodological quality

Jadad score : Not applicable
Allocation concealment : Not applicable
Publication Type : Journal Article ; Systematic Review