Traditional Chinese medicine treatment of asthma: From the insight on programmed cell death

Traditional Chinese medicine (TCM) is a time-honored and holistic practice that is used to treat various diseases. The extensive medicinal properties of TCM, particularly Chinese herbal medicines (CHMs), are well-established in the context of asthma treatment. The emerging concept of medicinal food homology (MFH) has focused considerable attention on the therapeutic efficacy and mechanisms of TCM in asthma treatment.

This review summarizes the role of programmed cell death (PCD) in asthma pathogenesis. It delineates the mechanisms and benefits of TCM in asthma treatment and presents a theoretical basis for asthma management via PCD modulation. Additionally, it offers insights into future research directions and challenges.

Pubmed, CNKI, Scopus and Web of Science databases were searched using the following keywords: "apoptosis," "autophagy," "ferroptosis," "pyroptosis," "necroptosis," "asthma," and "TCM". Articles on in vitro and in vivo studies and clinical trials from inception to March 2026 were selected for inclusion. Plant taxonomy was verified using the Medicinal Plant Names Services, Chinese Pharmacopoeia, and Plant List databases in March 2026. Contemporary research evidence integrated with TCM theory was used to summarize the mechanisms by which TCM active components suppress PCD and help manage asthma.

TCM mitigates asthma-related symptoms such as airway inflammation and remodeling via PCD modulation by regulating the expression of key proteins and signaling pathways. Mechanistically, in asthma, TCM compounds regulate apoptosis via the Bax/Bcl-2/caspase-3 and PI3K/Akt signaling axes, suppress autophagy by inhibiting the PI3K/Akt/mTOR pathway, alleviate ferroptosis via the GPX4/SLC7A11 axis, and block pyroptosis by targeting the NLRP3/caspase-1/GSDMD inflammasome. However, research on TCM-based regulation of necroptosis asthma remains limited. The therapeutic effects of TCM interventions for asthma are deeply rooted in TCM theories on lung, spleen, and kidney dysfunction and ethnopharmacological foundations, including MFH.

This review summarizes the role of PCD in asthma, furnishes a theoretical foundation for TCM-based interventions for asthma via PCD modulation, delineates the molecular mechanisms of the factors in the five primary PCD pathways, synopsizes the intervention mechanism and application of TCM in asthma treatment via PCD modulation, and presents reference concepts for the advancement of TCM interventions for asthma. The review concludes by identifying future research directions and limitations.