Natural bioactive as modulators of airway inflammation and remodeling: mechanistic insights

Airway diseases such as asthma, COPD, pulmonary fibrosis, and other inflammatory airway conditions remain a significant threat to global health. Traditional medicine (TM) has been extensively used over centuries to prevent and treat respiratory disorders due to its multi-component, multi-target therapeutic approach, and holistic nature. Increasing experimental evidence suggests that TM formulations have beneficial effects by modulating key pathological mechanisms, including oxidative stress, immune dysregulation, mucus hypersecretion, airway inflammation and hyperresponsiveness, and airway remodelling. However, the inherent complexity of TM, characterized by an abundance of bioactive constituents and synergistic effects, present significant challenges for mechanistic characterisation, standardization, and clinical authentication. Recent development in network pharmacology, artificial intelligence, and drug delivery systems based on nano formulations have presented potent tools to improve therapeutic efficacy, increase pulmonary targeting, and obtain a deeper understanding of TM mechanisms. Despite significant developments, the absence of large-scale, well-designed randomized controlled trials and consistent quality control persist as a major barrier to widespread clinical acceptance. This review summarizes current evidence on the role of traditional medicine in respiratory disease management, highlights key mechanism involved in and diseases incidents in experimental models and discusses future perspectives for integrating traditional medicine with modern scientific and clinical frameworks to support its evidence-based application in respiratory healthcare.