Objective To investigate the levels and clinical significance of serum soluble programmed death ligand-1 (sPD-L1), Toll-like receptor 4 (TLR4) and soluble intercellular adhesion molecule-1 (sICAM-1) in children patients with cough variant asthma (CVA). Methods The clinical data of 162 children patients with CVA in the hospital were collected. According to the clinical stages, the patients were divided into CVA acute stage group and CVA remission stage group. The clinical data of 124 patients with typical bronchial asthma (CA) admitted to the hospital during the same period were collected, and the patients were divided into CA acute stage group and CA remission stage group according to the clinical stages.36 children patients with non-respiratory diseases were included as control group. The levels of serum sPD-L1, TLR4 and sICAM-1, lung function ［forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum mid-expiratory flow (MMEF)］and airway responsiveness and sensitivity ［initial resistance value (Rrs cont), basal respiratory conductivity (Grs cont), minimum induced cumulative dose (Dmin), conductivity decline slope (sGrs)］were compared among the groups, and the relationship between lung function, airway responsiveness and sensitivity and levels of serum sPD-L1, TLR4 and sICAM-1 was evaluated among the children patients with CVA. Results There were no statistically significant differences in gender, age, height, weight, Rrs cont and Grs cont among the five groups (P>0.05). Comparison of serum sPD-L1 level and FVC, FEV1, MMEF, Dmin and sGrs among the five groups showed that CA acute stage group CVA acute stage group>CA remission stage group>CVA remission stage group>control group (P<0.05). Pearson correlation analysis showed that FVC, FEV1, MMEF, Dmin and sGrs in children patients with CVA were significantly positively correlated with serum sPD-L1 level (P<0.05), and were significantly negatively correlated with levels of serum TLR4 and sICAM-1 (P<0.05). Conclusion Levels of serum sPD-L1, TLR4 and sICAM-1 are correlated with lung function, airway responsiveness and sensitivity in children patients with CVA, and are beneficial for judging the development of the disease.