Background: Breathing exercises using game-based learning (GBL) strategy among asthmatic children' can help in increasing child health literacy, providing continuing interesting health education, improving respiratory health condition and stimulating the development of child learning motivation. Therefore, game-based learning is innovative educational method used with children, either traditional or digital, to provide a safe learning environment for practical experience. Aim: to determine the effect of breathing exercises game-based learning on asthmatic children' respiratory health and their learning motivation. Setting: A quasi-experimental design was conducted at the pediatric allergic center in Smouha clinic which affiliated to Health Insurance Hospital, in Alexandria, Egypt. Subjects: comprised of 70 school-age children who were selected conveniently and divided into control and study groups. Tools: Two tools were used. Tool one: "Pediatric Respiratory Assessment Measure (PRAM)". Tool two: "Asthmatic children' Learning motivation Questionnaire (ACLMQ)". Results: revealed that there was apparent improvement in the study group's scores than control group regarding asthma attacks characteristics, symptoms of asthma attacks, abscentism from the school, frequency of using asthma treatment, physical examination, using breathing exercises for asthmatic children', asthma severity, and learning motivation levels after 3 months of applying the intervention. Thus, there was a statistically significant difference between the study and control groups after such intervention in favor of the study group. Conclusion: GBL in the field of health education is more effective than traditional teaching methods to encourage children to cope with chronic disease, enhance learning motivation, to master new skills, and gain information through trial and error in a fun game. Recommendation: Educational workshops should be conducted for all pediatric nurses, and also clinical nurse educators to increase their competencies in applying GBL strategy, and integrating GBL in the nursing curriculum as an educational tool.