Impact of non-pharmacological adjuvant interventions on adult asthma patients: a systematic review and network meta-analysis.

Background: Adult asthma is a prevalent chronic respiratory disease. Non-pharmacological adjuvant interventions show promise in improving outcomes. This network meta-analysis (NMA) comprehensively evaluated the comparative efficacy of such interventions. Methods: Databases were searched from inception until August 2025 for randomized controlled trials (RCTs) on non-pharmacological interventions for adult asthma. Two reviewers independently performed study screening, data extraction, and risk-of-bias assessment using the revised tool for risk of bias in randomized trials (RoB 2). NMA was conducted using R 4.4.1 and Stata 17.0, with publication bias assessed via funnel plots. The quality of evidence was evaluated utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Results: Totally 37 RCTs involving 4,693 participants were included, encompassing 5 distinct intervention categories. Emphases were placed on six key asthma outcomes, namely asthma quality of life questionnaire (AQLQ), asthma control test (ACT), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and FEV1/FVC. Based on surface under the cumulative ranking curve (SUCRA) results and pairwise comparisons, breathing training (BT), mind-body therapy (MBT), and biopsychosocial approach (BA) showed the highest probability of improving ACT, FEV1/FVC and AQLQ, and FVC, FEV1 and PEF scores, respectively. Meta-regression analysis demonstrated that follow-up duration had no significant effect on each outcome. The funnel plot indicated no risk of potential publication bias. Based on the GRADE system for quality of evidence assessment, the overall evidence level of the included studies was moderate. Conclusions: The five non-pharmacological adjuvant interventions for adult asthma exhibited consistent effectiveness in mitigating asthma symptoms, improving living quality, and enhancing lung function. NMA showed that MBT, BA, and BT had only complementary relative efficacy in improving prognosis in asthma patients, with no clear differences in clinical superiority. Given the low GRADE certainty, these results should be interpreted with caution. Due to sparse network connections for some interventions and the fact that most comparisons relied on indirect evidence, the SUCRA results should be considered exploratory findings and are insufficient to offer definitive clinical recommendations. More high-quality studies are still needed to further validate the clinical application value and long-term efficacy of various interventions.