The promise of immunonutrition in pediatric pulmonary rehabilitation

The management of pediatric pulmonary diseases is increasingly evolving from conventional respiratory and physical interventions toward integrated strategies that incorporate nutritional and immunomodulatory approaches. Childhood represents a critical window for immune system development and maturation, during which nutritional status profoundly influences immune responses, inflammatory processes, and tissue repair-largely mediated through the gut-lung axis and multiple molecular pathways. This review comprehensively reviews the immunomodulatory roles of key nutrients-including vitamin D, ω-3 polyunsaturated fatty acids, prebiotics/probiotics, and branched-chain amino acids-in supporting lung rehabilitation in children. It elaborates on how these nutrients modulate innate and adaptive immunity, influence key inflammatory markers such as TNF-α and IL-6, and optimize the microecological milieu, thereby facilitating pulmonary function recovery, enhancing exercise tolerance and respiratory muscle strength, and reducing the risk of recurrent infections. Although compelling mechanistic insights have been provided by preclinical studies and some adult clinical trials, high-quality randomized controlled trials in pediatric populations remain limited. Moreover, existing evidence exhibits considerable heterogeneity in terms of intervention dosage, formulation, and individual responsiveness. Future research should prioritize well-designed, multicenter trials on precision nutrition interventions for children, incorporating advanced tools such as nanotechnology, metabolomics, and digital health technologies to establish standardized and personalized immunonutritional frameworks for pediatric pulmonary rehabilitation.