Background: Adolescents with asthma face unique challenges due to hormonal changes, psychosocial development and healthcare transition. Peer-led self-management programmes may increase treatment adherence and social adjustment by addressing these challenges. The purpose of this study was to assess whether peer-led self-management programmes improve health outcomes for adolescents with asthma. Methods: Sixteen databases were searched in May 2015 for published and unpublished studies. Studies had to be randomised controlled trials (RCTs), include participants aged 10-19 years old with asthma, use a peer-led educational intervention that addressed self-management of asthma, and report a measure of health status or behaviour as an outcome. Trial quality and data extraction were based on pre-specified criteria. Results were pooled using a random-effects model with mean differences (MDs). Subgroup analysis was not possible due to limited data. Results: Of the 1,887 articles retrieved, 4 studies (n = 1,937 participants) met the inclusion criteria. One study was excluded from meta-analysis due to unextractable data. There was a small, statistically nonsignificant increase in participants' quality of life (MD = 0.70, 95% confidence interval [CI] = -0.29, 1.69, p = 0.16), and a small, statistically non-significant decrease in lung function (MD = -1.36, 95% CI = -9.98, 7.26, p = 0.76). In one RCT, interventions reduced asthma symptoms and improved self-management. Scarcity of data made meta-analysis unfeasible, and studies had unclear or high risk of bias. Discussion: There is limited evidence that peer-led self-management programmes improve quality of life or lung function for adolescents with asthma. RCTs investigating more diverse and longer term outcomes are needed.