BACKGROUND: Various complementary or alternative medicines (including breathing exercises and yoga/pranayama) have been tried as an attractive option to pharmacotherapy in childhood asthma.OBJECTIVE: To evaluate the role of breathing exercise and yoga/pranayama as add on therapy to the "pharmacologically recommended treatment" of childhood asthma. METHODS: We searched the published literature through the major databases: Medline via Ovid, PubMed, CENTRAL, Embase, and Google Scholar till June 2018. Randomized trials comparing breathing exercises and yoga/ pranayama versus control or as part of a composite intervention versus control were included. The primary outcome measures were quality of life and change in asthma symptoms. Secondary outcomes were: decrease in medication use, number of exacerbations, change in lung function and immunological parameters, school absenteeism, and adverse events. RESULTS: A total of 10 trials (466 children, 6-14 years age) were included. The severity of asthma varied among the trials. The data for primary outcome measures could not be pooled, there were mixed results for both primary and secondary outcomes. No significant benefit was obtained in acute asthma, and the lung function tests [except PEFR % at 4-6 weeks, PEF absolute at 3 months, and FVC absolute at 3 months] in chronic asthma. One trial compared breathing exercise versus yoga, and found no difference. Adverse events were not significant. CONCLUSIONS: Breathing exercise and yoga/ pranayama may have some additive role in the treatment of childhood asthma. However, at present it cannot be recommended as a standard of care due to insufficient data.