Serious game-based interventions for pediatric asthma management: a systematic review and meta-analysis

Childhood asthma is a common chronic respiratory disease that can affect physical functioning, daily activities, and quality of life. Poor adherence and inadequate self-management remain important challenges in long-term asthma care. Serious games (SGs) combine game elements with health education, behavioral support, or rehabilitation and have been increasingly used in children with asthma. However, evidence regarding their clinical value has not been clearly established. This systematic review and meta-analysis aimed to evaluate the effects of SG-based interventions on pulmonary function, asthma-related knowledge, inflammatory biomarkers, healthcare utilization, engagement, adherence, and safety in children with asthma.

PubMed, Scopus, Embase via Ovid, Cochrane Library, CINAHL, Science Direct, SinoMed and CNKI were searched from inception to June 1, 2026. Studies examining SG-based interventions in children with asthma were eligible for inclusion. Study selection, data extraction, and methodological assessment were conducted independently by two reviewers. Pulmonary function outcomes that were sufficiently comparable across studies were pooled by meta-analysis, whereas the remaining outcomes were summarized narratively.

Eight studies were included. The interventions were classified as educational/self-management SG interventions or exercise/rehabilitation SG interventions. Meta-analyses included four studies for forced expiratory volume in 1 second (FEV1), four studies for FEV1/forced vital capacity (FVC), three studies for FVC, and three studies for maximal mid-expiratory flow (MMEF). Pooled analyses showed higher FVC [mean difference (MD) =4.48, 95% confidence interval (CI): 0.14 to 8.82] and MMEF (MD =8.41, 95% CI: 6.63 to 10.19) following SG-based interventions. No statistically significant differences were found for FEV1 (MD =1.90, 95% CI: -0.97 to 4.78) or FEV1/FVC [standardized mean difference (SMD) =-0.03, 95% CI: -0.26 to 0.20]. However, the certainty of evidence was limited by the small number of studies, small sample sizes, heterogeneity among interventions, and methodological limitations.

SG-based interventions may serve as a complementary approach to pediatric asthma management, particularly for selected pulmonary function outcomes and self-management-related behaviors. The finding for MMEF was relatively consistent, whereas the evidence for FVC was less robust. Interpretation is limited by the small number of available studies, small sample sizes, differences in intervention protocols, and methodological limitations. Larger, well-designed studies using standardized outcomes and longer follow-up are needed before the clinical value of SG-based interventions can be established.