Background: Asthma is a prevalent chronic disease with significant economic and health burdens worldwide. Its progression involves key hallmarks such as inflammation and airway remodeling, mediated by multiple inflammatory biomarkers and pathways. Despite the availability of potent therapeutic options, many patients continue to suffer from uncontrolled asthma. The plasminogen activator inhibitor-1 (PAI-1) signaling pathway plays a critical role in asthma exacerbation and remodeling, with elevated PAI-1 levels linked to disease progression. Bioactive compounds are increasingly studied for their potential in asthma management, and anthocyanins (ACNs), with promising anti-inflammatory properties, are among these novel compounds.

Methods and Findings: This comprehensive review explores the potential of ACNs in managing asthma-related inflammation and modulating PAI-1 levels to influence airway remodeling. ACNs have shown promise in asthma management, with epidemiological studies associating higher ACN intake with a lower risk of asthma and improved lung function. Preclinical models demonstrate ACNs’ effectiveness in reducing inflammatory cytokines, chemokines, and signaling pathways related to asthma. Limited human trials suggest ACNs may improve symptom control and lung function. While no direct evidence links ACNs to PAI-1 reduction in asthma, studies in other chronic conditions indicate their ability to reduce PAI-1 levels, supporting their potential role in asthma management. This highlights a promising avenue for further exploration into their effects on airway remodeling.

Conclusion: Preliminary evidence suggests ACNs may be effective as an adjunct to reduce inflammation and improve symptom control. However, the lack of robust human interventional studies remains a significant gap. Future research should focus on establishing direct evidence of ACNs’ impact on PAI-1 levels and airway remodeling in asthma.