Asthma – prevention and treatment with a plant-based diet

Image of lungs above article header
Posted by: Plant-Based Diet Team Post Date: March 23, 2022

Asthma – prevention and treatment with a plant-based diet

Asthma published article header

This article was published in the International Journal of Pulmonary & Respiratory Sciences


Asthma is the most common chronic disease of childhood. A plant-based diet can reduce the risk of asthma and can also be a step in the stepwise treatment of asthma.

There is evidence of the influence of food on asthma treatment outcomes, regardless of allergic status. Levels of inflammation, oxidative stress, and exposure to advanced glycation end products all contribute to the development of an asthmatic response, and can be reduced with a plant-based diet. Plant-based diet intervention studies on asthmatic patients have been shown to be effective at reducing symptoms and clinical measures.

A plant-based diet should be prescribed for all asthmatic patients.  Medications used to treat the asthma patient may need to be titrated down as the treatment effects of a plant-based diet become evident.

How to cite this article: Rose SD, Strombom AJ. Asthma – prevention and treatment with a plant-based diet.  Int J Pul & Res Sci. 2022; 5(5): 555672



Asthma is the most common chronic disease of childhood. The prevalence has been increasing at an alarming rate and has more than doubled in the last decade. Over 9 million children in the United States have been diagnosed with asthma, of whom 75% have active disease. (1)

Asthma is based on an aberrant immune response to non pathogenic stimuli in the airways, leading to a chronic inflammatory response relevant to the pathogenesis of the disease. The inflammation affects all compartments of the airways including the upper respiratory tract and the nose, with many cells and cellular elements playing a role, although the major physiological effect comprises the medium‐sized bronchi and the small airways. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment. (2) (3)

Several risk factors are associated with asthma morbidity and mortality, such as treatment non-adherence, exposure to environmental triggers, low income households, exposure to chronic stress, child psychological problems, parental stress, family functioning, obesity, physical inactivity, and unhealthy diets. These risk factors often have complex interactions and interrelationships. (4)

Rapid increases in worldwide asthma prevalence in only the past couple decades, especially in westernized countries, signal an important role of the environment factors including diet. (5)  A plant-based diet can reduce the risk of asthma and can also be a step in the stepwise treatment of asthma.



The Western diet, prevalent in developed countries, is dominated by convenience and highly processed foods, resulting in high intakes of refined grains, processed and red meats, desserts and sweets, fried foods, and high fat dairy products, with low intake of fruits and vegetables. (6)  In one study, higher cured meat intake increased the risk of worsening asthma symptoms over time by 76%, through a direct effect and to a lesser extent an effect mediated by BMI. (7)

An epidemiological study comparing vegetarian women to nonvegetarian women found that nonvegetarian women had a 24% increased risk of asthma. (8)  While a Mediterranean diet is not fully vegetarian, it includes much less meat and dairy, and more fresh fruits and vegetables, than the Western diet. Several studies have found that the Mediterranean diet had a protective effect against asthma, (9) (10) (11) (12) and a cross sectional study showed that high adherence to the Mediterranean diet increases the likelihood of asthma being under control in adults. (13)

Type 2 diabetes often presents as a comorbidity of asthma. Longitudinal observational studies have found a risk of between 21% and 37% of the incidence of Type 2 Diabetes Mellitus (T2DM) in adults with self-reported asthma (14) (15) (16). Thomsen et al. observed an almost doubled asthma risk in patients with T2DM compared to individuals without T2DM in a large study among Danish twins (17). Using administrative data from veterans’ hospitals, Hashemzadeh and Movahed (18) found that asthma was present in 4.5% of patients with T2DM vs. 2.9% in the control group, regardless of other comorbid conditions. Those following a plant-based diet have a 78% reduction risk of Type II diabetes mellitus (T2DM) (19)

Obesity alone also has a significant impact on asthma risk, phenotype, and prognosis. Epidemiological studies have clearly demonstrated that asthma is more likely to occur in obese patients, and health status is impaired in obese individuals with asthma, with such asthmatics experiencing more symptoms, worse quality of life, increased healthcare use, and increased asthma severity. (20) (21)

A healthy body mass index (BMI) range is 18-25 kg/m².  The average BMI on a typical American Diet is 28.8 kg/m², whereas the average BMI on a vegan diet is 23.6 kg/m² (22)  Vegans have a 65% decreased risk of being overweight or obese. (23)

Vegetarian children also have a lower BMI than their meat-eating counterparts, with the average BMI of a vegetarian child being 17.3 kg/m² at age 6-11, compared to 18.5 kg/m² for a non-vegetarian child, and 20.0 kg/m² at age 12-18, compared to 22.3 kg/m² for a non-vegetarian child. (24)

With the reduced risk of obesity, one would expect the risk of asthma to be reduced for those on a vegetarian diet as well.  Indeed, the prevalence of current wheezing was significantly lower in children on a vegetarian diet. The effect was especially strong in girls. (25)  One study found that frequent consumption of vegetables and grains, and low consumption of dairy products, is associated with lower plasma levels of IL-17F cytokine and decreased risk of childhood asthma. (26)



Although asthma has long been considered a single disease, recent studies have increasingly focused on its heterogeneity. (27)  The pathophysiology of asthma is complex, involving various host-environment interactions occurring at various scales, from genes to organs. (28) The characterization of this heterogeneity has led to the concept that asthma consists of various “phenotypes” or consistent groupings of characteristics. (27)  These include syndromes characterized by allergen-exacerbated, nonallergic, and aspirin-exacerbated factors, along with syndromes best distinguished by their pathologic findings (eosinophilic, neutrophilic, pauci-granulocytic), response to therapy (corticosteroid resistant), and natural history (remodeling prone). (29)

A study by Julia et al. has found that the role of diet may be a key factor influencing the development of allergic diseases (30). There is evidence of the influence of food on asthma treatment outcomes, regardless of allergic status. (31)

Dietary factors show the potential of being directly involved in the pathogenesis of asthma. (32) (33) Han et al. (26) observed a positive association between consumption of dairy products and pro inflammatory interleukin (IL)-17F concentrations. The mechanisms by which dairy products may influence the development or course of asthma are not clear, but may include responses to milk proteins or milk lipids. (34)


Population-based studies showed a correlation between increased levels of serum high sensitivity-CRP (hs-CRP) with a high frequency of airway hyper-responsiveness and low forced expiratory volume in one second (FEV1) among asthmatics without heart disease. (35)

One study found that serum concentrations of hs-CRP were significantly increased in asthmatic patients, and in steroid-native patients it partly correlated with FEV1 and numbers of sputum eosinophils. This suggests that serum hs-CRP can indirectly indicate the degree of airway inflammation. (36)

Another study showed a negative correlation between FEV1 and haptoglobulin level in men. (37) This relationship indicates that with increasing severity of disease and further reduction of FEV1, the inflammatory process and its serum markers will increase.

A plant-based diet has been shown to reduce markers of inflammation such as hs-CRP. Lower levels of hs-CRP were found in those following a vegetarian diet for more than 2 years (38, 39). An interventional study found that after 8 weeks on a vegan diet, hs-CRP was reduced 32%, even more than the American Heart Association diet. (40)

Oxidative Stress

Studies have indicated that oxidative stress also plays an important role in the development of asthma (41). Reactive oxygen species (ROS) present in asthmatic airways are derived from many sources, including exposure to environmental peroxidants, infiltration of inflammatory cells in the airway, metabolic disorders, and decreased levels of cellular antioxidants. Airway oxidative stress also has been associated with declining disease status, poor lung function, and epigenetic changes (42).

A plant-based diet protects against chronic oxidative-stress-related diseases. Dietary plants contain variable chemical families and amounts of antioxidants. Plant antioxidants may contribute to the beneficial health effects of dietary plant foods. (43) On average plant foods provide 11.57 mmol/100gm antioxidant content, while animal foods provide only on average 0.18 mmol/100gm. (43)

Advanced Glycation End Products

Dietary advanced glycation end products (AGEs) are highly oxidant, proinflammatory compounds, with highest levels present in cooked meats. (44) AGEs are ligands for the AGE receptor (RAGE), a pattern recognition and danger signal receptor, with highest expression in the lungs, and an important driving force behind downstream Th-2 inflammation. (45) AGEs directly stimulate the inflammatory response of humans’ innate immune cells. (46)

In one study, higher AGE intake was significantly associated with increased risk of wheezing, wheeze-disrupted sleep and exercise and wheezing requiring prescription medication. (47)

AGEs have higher concentration in meat and dairy than in most plant foods, ranging from butter (26,480 units/100gram), chicken broiled, (8,299 units/100gram) and McDonald’s Hamburger (5,418 units/100gram) to a veggie burger (Boca Burger, microwaved) having only 67 units/100gram. (48) (49) (44)

Higher intake of meats was associated with wheeze-disrupted sleep (2.32; 95% CI 1.11 to 4.82) and wheezing requiring prescription medication (2.23; 95% CI 1.10 to 4.54 (47)



Several studies have assessed the treatment of asthmatic patients with a plant-based diet.

One study with 46 participants, comparing the effects of weight loss achieved by dietary restriction, exercise or a combination on airway inflammation and clinical outcomes in overweight and obese adults with asthma over a 10-week period, found that a reduction of dietary saturated fat intake was associated with a reduction in neutrophilic airway inflammation in asthmatics, compared to those who only exercised. (50)

In another study, after 14 weeks, subjects consuming a low-antioxidant diet had a lower percentage predicted forced expiratory volume in 1 second and percentage predicted forced vital capacity than did those consuming the high-antioxidant diet. Subjects in the low-antioxidant diet group had increased plasma C-reactive protein (CRP) at week 14. At the end of the trial, time to exacerbation was greater in the high-antioxidant than in the low-antioxidant diet group, and the low-antioxidant diet group was 2.26 times as likely to have exacerbated symptoms. (51)

In a study of 35 asthmatic patients, 20 of whom had been admitted to hospital for acute asthmatic attacks during the past 2 years, and who had suffered from bronchial asthma for an average of 12 years, all receiving long-term medication, were treated with a vegan diet for 1 year.  In almost all cases, medication was withdrawn or drastically reduced. There was a significant decrease in asthma symptoms. 71% of patients reported improvement at 4 months and 92% at 1 year. There was a significant improvement in a number of clinical variables including vital capacity, forced expiratory volume at one second, and physical working capacity, as well as a significant change in various biochemical indices as haptoglobin, IgM, IgE, sed rate (ESR), cholesterol, and triglycerides in blood. (52)

These studies show that a plant-based diet may be an efficacious treatment or adjunct treatment for asthma.


Clinical Considerations

Asthma is a chronic disease requiring ongoing and comprehensive treatment aimed at reducing the symptom burden (i.e. good symptom control while maintaining normal activity levels), and minimizing the risk of adverse events such as exacerbation of symptoms, fixed airflow limitation and treatment side effects. (2) (53)

Asthma treatment is based on a stepwise approach. The management of the patient is control-based; that is, it involves an iterative cycle of assessment (symptoms, risk factors, etc.), adjustment of treatment (i.e. pharmacological, non-pharmacological and treatment of modifiable risk factors) and review of the response (symptoms, side effects, exacerbations, etc.). (53)

Pharmacologic treatment with beta-agonists for intermittent asthma and inhaled corticosteroids and a combination of inhaled corticosteroids and long-acting beta-2 agonists for persistent asthma are recommended. Additional and alternative treatments with leukotriene modifiers, anticholinergics, biologics, and bronchial thermoplasty are also available. (54)

A plant-based diet should be prescribed for all asthma patients.  Medications used to treat the asthma patient may need to be titrated down as the treatment effects of a plant-based diet become evident.

When treating patients with common comorbidities such as type II diabetes or coronary artery disease, medications specifically for these conditions will also need to be titrated as the treatment effects on these comorbidities become evident. For instance, plant-based diet is more efficacious in treating type 2 diabetes and as efficacious as Lovastatin in treating hypercholesterolemia. (19, 55)



Asthma is a chronic disease and has an effect on quality of life for the patient. The cost of treatment can be considerable, especially over time and for the uninsured or under-insured. Treating the patient with a plant-based diet can reduce symptoms, the need for medication and, for adult patients, prevent and treat common comorbidities.

While medication will always have its place, a plant-based diet can be a valuable adjunct to standard care or, in some cases, a monotherapy. This is especially the case considering that it has no adverse reactions or contraindications. Vegetarian and vegan diets are no longer out of the mainstream of awareness, as was the case many years ago, and a plant-based diet costs no more than a meat-centered one. It can therefore be offered as a treatment to all patients.

One weakness of this review is that many studies do not differentiate between different phenotypes of asthma. Therefore, we cannot tell if a plant-based diet is a more efficacious in preventing or treating some phenotypes than others.




Toskala E, Kennedy D. (2015) Asthma risk factors. Int Forum Allergy Rhinol. 5 Suppl 1(Suppl 1):S11-S16. PubMed


Global Initiative for Asthma (GINA). (2017) Global Strategy for Asthma Management and Prevention. Bethesda: US Department of Health and Human Services; GINA


Bjermer L. (2001) History and future perspectives of treating asthma as a systemic and small airways disease. Respir Med. 95(9):703–719. PubMed


Oland AA, Booster GD, Bender BG. (2017) Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. World Allergy Organ J. 10(1):35 PubMed


Cooper P, Rodrigues L, Cruz A, Barreto M. (2009) Asthma in Latin America: a public heath challenge and research opportunity. Allergy. 64(1):5–17. PubMed


Hu FB. (2002) Dietary pattern analysis: A new direction in nutritional epidemiology. Curr Opin Lipidol. 13(1):3–9. PubMed


Li Z, Rava M, Bédard A, Dumas O, Garcia-Aymerich J, et al. (2017) Cured meat intake is associated with worsening asthma symptoms. Thorax. 72(3):206-212. PubMed


Knutsen S. (1994) Lifestyle and the use of health services. Am J Clin Nutr. 59(5 Suppl):1171S–1175S. PubMed


Chatzi L, Kogevinas M. (2009) Prenatal and childhood Mediterranean diet and the development of asthma and allergies in children. Public Health Nutr. 12(9A):1629–1634. PubMed


Rice J, Romero K, Galvez Davila R, Meza C, Bilderback A, et al. (2015) Association between adherence to the Mediterranean diet and asthma in Peruvian children. Lung. 193(6):893–899. PubMed


Papamichael M, Itsiopoulos C, Susanto N, Erbas B. (2017) Does adherence to the Mediterranean dietary pattern reduce asthma symptoms in children? A systematic review of observational studies. Public Health Nutr. 20(15):2722–2734. PubMed


de Batlle J, Garcia-Aymerich J, Barraza-Villarreal A, Antó J, Romieu I. (2008) Mediterranean diet is associated with reduced asthma and rhinitis in Mexican children. Allergy. 63(10):1310–1316. PubMed


Barros R, Moreira A, Fonseca J, de Oliveira J, Delgado L, et al. (2008) Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control. Allergy. 63(7):917-923. PubMed


Mueller NT, Koh WP, Odegaard AO, Gross MD, Yuan JM, et al. (2013) Asthma and the risk of type 2 diabetes in the Singapore Chinese Health Study. Diabetes Res Clin Prac. 99(2):192–199. PubMed


Song Y, Klevak A, Manson JE, Buring JE, Liu S. (2010) Asthma, chronic obstructive pulmonary disease, and type 2 diabetes in the Women’s Health Study. Diabetes Res Clin Prac. 90(3):365–371. PubMed


Yun HD, Knoebel E, Fenta Y, Gabriel SE, Leibson CL, et al. (2012) Asthma and proinflammatory conditions: a population-based retrospective matched cohort study. Mayo Clinic Proceedings. 87(10):953–960. PubMed


Thomsen SF, Duffy DL, Kyvik KO, Skytthe A, Backer V. (2011) Risk of asthma in adult twins with type 2 diabetes and increased body mass index. Allergy. 66(4):562–568. PubMed


Hashemzadeh M, Movahed MR. (2009) The occurrence of asthma in hospitalized patients with type 2 diabetes mellitus. Intern Med J. 39(10):699–701. PubMed


Strombom A, Rose S. (2017) The prevention and treatment of Type II Diabetes Mellitus with a plant-based diet. Endocrin Metab Int J. 5(5):00138. MedCrave


Weiss S. (2005) Obesity: insight into the origins of asthma. Nat Immunol. 6(6):537–539. PubMed


Sutherland E. (2014) Linking obesity and asthma. Ann N Y Acad Sci. 1311:31–41 PubMed


Tonstad S, Butler T, Yan R, Fraser GE. (2009) Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 32(5):791-796. PubMed


Newby PK, Tucker KL, Wolk A. (2005) Risk of overweight and obesity among semivegetarian, lactovegetarian, and vegan women. Am J Clin Nutr.81(6):1267-1274. PubMed


Haddad EH, Tanzman JS. (2003) What do vegetarians in the United States eat? Am J Clin Nutr. 78(3 Suppl):626S-632S. PubMed


Jan RH, Wen SH. (2007) The relationship between vegetarian diets and the prevalence of asthma, allergic rhinitis and atopic eczema in Taiwanese school children. Tzu Chi Med J. 19(2):60-65. PDF


Han YY, Forno E, Brehm JM, Acosta-Pérez E, Alvarez M, et al. (2015) Diet, interleukin-17, and childhood asthma in Puerto Ricans. Ann Allergy Asthma Immunol. 115(4):288-293.e1. PubMed


Wenzel S. (2012) Asthma phenotypes: the evolution from clinical to molecular approaches. Nat Med. 18(5):716–725. PubMed


Papi A, Brightling C, Pedersen S, Reddel H. (2018) Asthma. Lancet. 391(10122):783–800. PubMed


Borish L, Culp J. (2008) Asthma: a syndrome composed of heterogeneous diseases. Ann Allergy Asthma Immunol. 101(1):1-8, quiz 8-11, 50. PubMed


Julia V, Macia L, Dombrowicz D. (2015) The impact of diet on asthma and allergic diseases. Nat. Rev. Immunol. 15:308–322. PubMed


Hijazi N, Abalkhail B, Seaton A. (2000) Diet and childhood asthma in a society in transition: A study in urban and rural Saudi Arabia. Thorax. 55(9):775–779. PubMed


Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, et al. (2006) Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 368(9537):733–743. PubMed


Guo CH, Liu PJ, Lin KP, Chen PC. (2012) Nutritional supplement therapy improves oxidative stress, immune response, pulmonary function, and quality of life in allergic asthma patients: An open-label pilot study. Altern Med Rev. 17(1):42–56. PubMed


Haas F, Bishop MC, Salazar-Schicchi J, Axen KV, Lieberman D, et al. (1991) Effect of milk ingestion on pulmonary function in healthy and asthmatic subjects. J Asthma. 28(5):349–355. PubMed


Sunyer J, Pistelli R, Plana E, Andreani M, Baldari F, et al. (2008) Systemic inflammation, genetic susceptibility and lung function. Eur Respir J. 32(1):92-97. PubMed


Halvani A, Tahghighi F, Nadooshan H. (2012) Evaluation of correlation between airway and serum inflammatory markers in asthmatic patients. Lung India. 29(2):143-146. PubMed


Kauffmann F, Frette C, Annesi I, Oryszczyn M, Dore M, et al. (1991) Relationships of haptoglobin level to FEV1, wheezing, bronchial hyper-responsiveness and allergy. Clin Exp Allergy. 21(6):669–674. PubMed


Szeto Y, Kwok T, Benzie I. (2004) Effects of long-term vegetarian diet on biomarkers of antioxidant status and cardiovascular disease risk. Nutrition. 20(10):863-866. PubMed


Haghighatdoost F, Bellissimo N, Totosy de Zepetnek J, et al. (2017) Association of vegetarian diet with inflammatory biomarkers: a systematic review and meta-analysis of observational studies. Public Health Nutrition.20(15):2713-2721 PubMed


Shah B, Newman J, Woolf K, Ganguzza L, Guo Y et al. (2018) Anti-Inflammatory Effects of a Vegan diet versus the American Heart Association-recommended diet in coronary artery disease trial. J Am Heart Assoc. 7(23):e011367. PubMed


Nadeem A, Siddiqui N, Alharbi N, Alharbi M. (2014) Airway and systemic oxidant-antioxidant dysregulation in asthma: a possible scenario of oxidants spill over from lung into blood. Pulm Pharmacol Ther. 29(1):31-40. PubMed


Holguin F. (2013) Oxidative stress in airway diseases. Ann Am Thorac Soc. 10 Suppl:S150-S157. PubMed


Carlsen M, Halvorsen B, Holte K, Bøhn S, Dragland S, et al. (2010) The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide. Nutr J. 9:3. Nutrition Journal


Uribarri J, Woodruff S, Goodman S, Cai W, Chen X, et al. (2010) Advanced glycation end products in foods and a practical guide to their reduction in the diet. J Am Diet Assoc. 110:911–916.e12. PubMed


Oczypok E, Perkins T, Oury T. (2017) All the “RAGE” in lung disease: The receptor for advanced glycation endproducts (RAGE) is a major mediator of pulmonary inflammatory responses. Paediatr Respir Rev. 23:40–49. PubMed


van der Lugt T, Weseler A, Gebbink W, Vrolijk M, Opperhuizen A, et al. (2018) Dietary advanced glycation endproducts induce an inflammatory response in human macrophages in vitro. Nutrients. 10(12):1868. PubMed


Wang JG, Liu B, Kroll F, Hanson C, Vicencio A, et al. (2021) Increased advanced glycation end product and meat consumption is associated with childhood wheeze: analysis of the National Health and Nutrition Examination Survey. Thorax. 76:292-294. PubMed


Goldin A, Beckman JA, Schmidt AM, Creager MA. (2006) Advanced glycation end products: sparking the developmeent of diabetic vascular injury. Circulation. 114(6):597-605. PubMed


Basta G, Lazzerini G, Massaro M, Simoncini T, Tanganelli P, et al. (2002) Advanced glycation end products activate endothelium through signal-transduction receptor RAGE: a mechanism for amplificationof inflammatory responses. Circulation. 105(7):816-822. PubMed


Scott. HA, Gibson PG, Garg ML, Pretto JJ, Morgan PJ, et al. (2013) Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: A randomized trial. Clin Exp Allergy. 43(1):36–49. PubMed


Wood LG, Garg ML, Smart JM, Scott HA, Barker D, et al. (2012) Manipulating antioxidant intake in asthma: a randomized controlled trial. Am J Clin Nutr. 96(3):534–543. PubMed


Lindahl O, Lindwall L, Spångberg A, Stenram A, Ockerman P. (1985) Vegan regimen with reduced medication in the treatment of bronchial asthma. J Asthma. 22(1):45-55. PubMed


Global Initiative for Asthma. (2019) Pocket guide for asthma management and prevention; PDF


So JY, Mamary AJ, Shenoy K. (2018) Asthma: Diagnosis and treatment. Eur Med J. 3(4):111-121. PDF


Rose S, Strombom A. (2018) A comprehensive review of the prevention and treatment of heart disease with a plant-based diet. J Cardiol & Cardiovas Ther. 12(5):555847. PDF


Share this post