Biologically Active Ingredients and Underlying Mechanisms of <i>Cordycep</i> s in Treating Respiratory Diseases: A Comprehensive Review With Future Perspectives

The incidence of respiratory diseases is increasing worldwide and imposes a significant health burden. Due to the complex etiology and diverse inducements of these diseases, existing therapies often struggle to control disease progression and reduce recurrence rates. Therefore, the medical community continues to explore novel strategies derived from natural medicines. As a precious traditional fungus, Cordyceps has long been used for nourishing the lungs in Asia. Extensive reports demonstrate that Cordyceps exhibits considerable potential in the treatment of respiratory diseases. This review seeks to comprehensively summarize the biologically active ingredients and underlying mechanisms of Cordyceps in the treatment of respiratory diseases. The aim is to offer valuable insights for future development of Cordyceps. The literature search is conducted in PubMed, Web of Science, Science Direct, and CNKI for publications from 2007 to 2025. The keywords include "Cordyceps", "respiratory diseases", "chronic obstructive pulmonary disease", "pulmonary fibrosis", "pneumonia", "cordycepin", "polysaccharide", "ergosterol", and other related terms. Both Chinese and English terms are used for the CNKI database. Literature consisting of original research and reviews on Cordyceps active ingredients for respiratory diseases is included. Non-respiratory system research, non-peer-reviewed literature, and repetitive literature are excluded. After eligibility screening, 194 studies are included in the final analyses. Nucleosides, polysaccharide and sterols emerge as the principal ingredients in Cordyceps, which exhibit significant function against respiratory diseases. The mechanisms mainly involve alleviating oxidative stress, inhibiting inflammatory reaction, modulating immune response and others. Up to now, Cordyceps does not show obvious toxic side effects in preclinical and clinical studies. Cordyceps is a promising fungal source. This review comprehensively analyzed the biologically active ingredients and elucidated the underlying mechanisms of Cordyceps in the treatment of respiratory diseases. The paper would provide evidence for clinical use of Cordyceps and lay a foundation for its future development.