Asthma (Naja et al., 2018) is one of the most prevalent chronic respiratory diseases in children worldwide, affecting approximately one in every eleven children and adolescents (Edwards et al., 2025). Clinically, it is characterized by recurrent episodes of wheezing, shortness of breath, chest tightness, and cough, with symptoms often worsening at night and in the early morning (de Benedictis et al., 2025). Epidemiological evidence indicates that an estimated 80–95 million children globally are currently affected by asthma (Zheng et al., 2025). The prevalence of childhood asthma varies substantially across regions, with overall rates ranging from approximately 9% to 14%, and exceeding 20% in some areas (Zhou & Tang, 2025), underscoring the substantial global public health burden posed by childhood asthma.

Asthma, particularly when poorly controlled, can have profound and recurrent impacts on children's physical health (Bonomo et al., 2025; Gedeon et al., 2023; Li et al., 2025) and health-related quality of life (Al-Iede et al., 2025; Kasse et al., 2024; Plaza-González et al., 2022). Evidence suggests that, compared with healthy peers, children with asthma are more likely to experience obesity and sleep disturbances, partly due to weight gain associated with long-term corticosteroid use (Mazzotta & Barkai, 2025) and reduced sleep quality caused by frequent nocturnal dyspnea and cough (Leite et al., 2025). Recurrent healthcare visits and persistent concerns about asthma exacerbations often lead to school absenteeism and activity restrictions, further compromising academic performance and social participation (Garr et al., 2025; Hansen et al., 2025). Consequently, these children are prone to experience anxiety, fear, and self-blame (Bardach et al., 2019; Kulikova et al., 2021), with studies reporting that approximately 15. 8% to 47. 4% of children with asthma exhibit symptoms of anxiety or depression (Agu et al., 2023). School age represents a critical developmental period for children's physical, psychological, and social growth, and is also a stage during which children with asthma face multiple challenges (Stridsman et al., 2024). During this period, rapid physical development, increased levels of physical activity, and greater exposure to allergens and environmental triggers contribute to more pronounced variability and recurrence of asthma symptoms (Johnston et al., 2006; Lu et al., 2022; McClure et al., 2018). Unlike preschoolers, who are highly dependent, or adolescents, who experience strong emotional fluctuations, school-aged children with asthma are in a transitional phase characterized by increasing independence but limited maturity. Parental guidance and emotional support are therefore particularly crucial for effective disease management and psychological adjustment (Wang et al., 2024).

As the primary caregivers of children with asthma, parents or grandparents are more likely than caregivers of healthy children to experience psychological distress due to the ongoing demands of managing fluctuating symptoms, making medical decisions, and allocating family resources (Wu, Zhang, & Hu, 2025), which increases their risk of anxiety and depression (Weinstein et al., 2019). Caregivers' psychological well-being not only affects their own health but also has cascading effects on the family climate and the emotional support available to the child (Peters et al., 2017; Plaza-González et al., 2022). Therefore, it is necessary to consider children with asthma and their primary caregivers as a unit and to explore strategies to alleviate the psychological burden on families affected by asthma.

Against this background, the concept of family resilience (Patterson, 2002) has attracted increasing scholarly attention. Rooted in positive psychology, family resilience conceptualizes the family as an integrated functional system and focuses on its capacity to maintain and restore functioning in the face of adversity while achieving positive adaptation and growth. It buffers the adverse impact of illness-related stress on mental health by mobilizing the family's collective coping resources, thereby promoting more favorable psychological outcomes. A growing body of evidence suggests that higher levels of family resilience are closely associated with better psychological and health outcomes. For example, among breast cancer survivors, family resilience has been shown to have a significant direct effect on subjective well-being (Li et al., 2019). In families of children with leukemia, interventions targeting the enhancement of family functioning and resilience play a key role in promoting parental mental health during treatment (Ferraz et al., 2025). However, most existing research has focused on other chronic conditions such as cancer. Directly transferring findings or intervention models from these conditions to families of children with asthma may overlook the distinctive features of asthma, including its recurrent nature, symptom unpredictability, and the need for continuous environmental management. This may, in turn, compromise the precision and appropriateness of clinical assessment and intervention. The theoretical framework proposed by Walsh (2016) is particularly well suited to understanding chronic conditions such as asthma, characterized by recurrence, uncertainty, and long-term management. Walsh conceptualizes family adaptation, recovery, and growth as dynamic processes unfolding across three core dimensions: (1) belief systems, including making meaning of adversity, maintaining a positive outlook, and drawing strength from transcendence and spirituality; (2) organizational patterns, encompassing flexibility, connectedness, and access to social and economic resources; and (3) communication processes, emphasizing clear communication, open emotional expression, and collaborative problem-solving. Within this framework, family belief systems shape how children with asthma and their caregivers interpret the meaning of the illness, construct hope, and sustain adaptive coping. Organizational patterns determine the family's flexibility and stability in managing treatment burdens, allocating roles, and mobilizing social resources. Communication processes are directly linked to information sharing, emotional regulation, and collaborative decision-making in symptom management.

Importantly, family resilience does not operate independently of cultural contexts; values, intergenerational arrangements, and access to resources within different sociocultural settings substantially shape how resilience is expressed (Liu et al., 2025). In the Chinese cultural context, for example, Confucian familism emphasizes elder involvement, parental responsibility, and intergenerational solidarity. The demographic effects of the one-child policy have further intensified parental attention toward school-aged children with asthma. This context not only strengthens caregivers' sense of responsibility in disease management but also amplifies children's emotional responses and subjective psychological experiences within parent–child interactions. Moreover, previous research on family resilience has largely been limited to adult perspectives, such as those of primary caregivers or partners, often neglecting children's own psychological experiences and their position within the parent–child interaction system. Given the inherent power asymmetry and differences in reciprocity between parents and children (Chen et al., 2025), children's coping strategies and emotional responses may differ substantially from those of their caregivers. The present study therefore collected narratives from both children and caregivers to explore their potentially divergent experiences and strategies in responding to asthma. By contrasting these two perspectives, the study seeks to reveal aspects of family psychological coping that may not be captured through a single-perspective approach. Because family resilience is inherently a dynamic process of adaptation, recovery, and growth, it is often difficult to capture fully through quantitative indicators alone. Qualitative inquiry is therefore better suited to illuminating how families of school-aged children with asthma engage in meaning-making, negotiate roles, and navigate communication processes during long-term caregiving, in order to sustain and enhance family resilience.

Therefore, this study was guided by Walsh's family resilience framework (as shown in Fig. 1). The Chinese version of this theoretical framework has undergone cultural adaptation and psychometric validation in domestic studies, demonstrating satisfactory applicability and reliability within the Chinese context (Li et al., 2016). A qualitative approach was employed to explore, from the dual perspectives of children with asthma and their primary caregivers, their coping experiences during the course of illness management within the Chinese cultural context, with particular attention to three domains: family belief systems, organizational patterns, and communication processes. This study aimed to explore how school-age children with asthma and their primary caregivers jointly experience and cope with illness-related challenges, using Walsh's Family Resilience Framework to identify adaptive and maladaptive processes.