Aim: Children with Down syndrome are vulnerable to respiratory tract infections due to anatomical deformities. The aim of the present study wasto evaluate the effect of game-based breathing exercise on respiratory tract infections in children with Down syndrome. Methods: Twelve children with Down syndromewere randomly allocated into 2 groups, the intervention and the control group.The intervention group participated in game-based breathing exercise for 20 minutes a day, 2 days a week, for a period of 3 months. For the statistical analysis we use the Friedman Test in SPSS Statistics, a non-parametric alternative test, as we hadrepeated measures. Results: We found a positive effect of respiratory game-based breathing exercise on respiratory tract infections. Conclusion: Respiratory game-based physiotherapy can help children with Down syndrome to reduce respiratory tract infections keywords : Down syndrome, morbidity, respiratory tract infections, respiratory physical therapy