Conventional and Complementary Management of Bronchial Asthma: A Structured Narrative Review with Quantitative Evidence Synthesis

Bronchial asthma is a prevalent chronic inflammatory disorder, characterized by airway hyperresponsiveness and reversible airflow limitation. India bears a disproportionate burden with approximately 34.3 million affected individuals (13.09% of global burden), three times higher mortality, and two times higher disability-adjusted life years compared to global averages. Conventional management per Global Initiative for Asthma 2024 guidelines relies on inhaled corticosteroid-formoterol combinations, with a paradigm shift away from short-acting beta-2 agonist monotherapy. While effective for symptom control, pharmacotherapy does not address all underlying psychosomatic and lifestyle factors. Complementary approaches, including yoga therapy, pranayama, naturopathy, herbal medicine, and acupuncture, are widely used as adjuncts. A structured search of PubMed, Scopus, the Cochrane Library, and Google Scholar (database inception to March 2025) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 reporting framework, with prespecified inclusion and exclusion criteria and a documented screening flow. The certainty of evidence was appraised narratively using Grading of Recommendations Assessment, Development and Evaluation concepts, and published pooled effect estimates were tabulated as a quantitative synthesis. The strongest available evidence indicates that yoga and breathing exercises produce small, moderate-certainty improvements in asthma-related quality of life and symptoms, whereas their effect on objective lung function (e.g., forced expiratory volume in 1 s) is small and statistically nonsignificant in pooled Cochrane analyses. Acupuncture shows inconsistent lung function effects and carries rare but serious risks such as pneumothorax. Several herbal agents have biological plausibility but variable clinical data and important drug interactions. Claims previously made for these modalities have been tempered to match the underlying evidence, and a dedicated assessment of safety, contraindications, and methodological limitations is provided. Complementary therapies should be positioned as carefully selected adjuncts to – not substitutes for – guideline-based pharmacotherapy, pending adequately powered, standardized randomized trials.