Objective To investigate the effects of lactobacillus bifidobacterium triactive tablets combined with Montelukast sodium on inflammatory response and serum tissue inhibitor of matrix metalloproteinase -1 (TIMP-1) and cysteinotriene (CysLTs) levels in children with cough variant asthma (CVA).Methods The medical records of 97 cases of CVA children admitted to Taiyuan Maternal and Child Health Hospital from April 2022 to May 2024 were retrospectively analyzed, and they were divided into control group (48 cases, received Montelukast sodium) and observation group (49 cases, received lactobacillus bifidobacterium triactive tablets combined with Montelukast sodium) by treatment method. Both groups were treated for 3 months. The clinical efficacy, inflammatory response, airway remodeling, serological indexes, lung function and adverse reactions were compared in 2 groups.Results The observation group with total effective rate was higher than control group (P < 0.05). The observation group with difference of macrophage inflammatory protein-1α (MIP-1α), γ-interferon (IFN-γ) and eosinophilic chemotactic factor (Eotaxin) before and after treatment were higher than control group (P < 0.05). The observation group with differences of airway wall thickness, airway cross-sectional area and airway wall area before and after treatment were higher than control group (P < 0.05). The difference of TIMP-1 and CysLTs before and after treatment in observation group was higher than control group (P < 0.05). The observation group with difference of maximum expiratory peak flow rate (PEF), forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) before and after treatment were higher than control group (P < 0.05). There was no difference in total adverse reactions incidence in 2 groups (P > 0.05).Conclusion Children with CVA were treated with bifidobacterium Lactobacillus triple viable tablets combined with Montelukast sodium, which can improve lung function, reduce inflammation, reverse airway remodeling, regulate serum TIMP-1 and CysLTs expression, and is safe and reliable.