BackgroundAsthma is a heterogeneous chronic inflammatory airway disease affecting over 300 million people globally. Inhaled corticosteroids remain first-line therapy but cause adverse effects and fail to address core pathologies in 5%–10% of patients—particularly those with Type 2-low endotypes exhibiting glucocorticoid resistance. Natural medicines, with multi-component synergy, offer a promising strategy to bridge this gap.ObjectiveThis review synthesizes advances in botanical extracts and bioactive constituents for asthma management, focusing on pharmacological mechanisms aligned with asthma endotypes.MethodsA literature search across PubMed and Web of Science (2010–2026) included preclinical studies and randomized controlled trials (RCTs). Therapeutic effects were categorized into anti-inflammation, antioxidant modulation, immunoregulation, and anti-remodeling.ResultsBotanical therapeutics concurrently restore epithelial barrier integrity, rebalance Th1/Th2/Th17 immunity, activate Nrf2-mediated antioxidant pathways, and inhibit airway remodeling. RCTs demonstrate adjunctive benefits in mild-to-moderate asthma; however, translational bottlenecks persist, including phytochemical bioavailability issues and insufficient biomarker-stratified data.ConclusionNatural medicines overcome limitations of single-target synthetic drugs via multi-dimensional intervention. Clinical translation necessitates standardized formulations, advanced pulmonary delivery systems, rigorous safety evaluations—including herb-drug interactions—and endotype-stratified RCTs.