Prevalence and management of severe asthma in primary care: an observational cohort study in Sweden (PACEHR)

Larsson, Kjell; Ställberg, Björn; Lisspers, Karin; Telg, Gunilla; Johansson, Gunnar; Thuresson, Marcus; Janson, Christer

doi:10.1186/s12931-018-0719-x

Cited by 101Asthma and respiratory diseasesChronic Obstructive Pulmonary Disease (COPD) ResearchOccupational exposure and asthma

Prevalence and management of severe asthma in primary care: an observational cohort study in Sweden (PACEHR)

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Larsson, Kjell, Ställberg, Björn, Lisspers, Karin, Telg, Gunilla, Johansson, Gunnar, Thuresson, Marcus, Janson, Christer·2018·Respiratory Research

DOI 10.1186/s12931-018-0719-xPMC PMC5774144

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Abstract

BACKGROUND: Severe and uncontrolled asthma is associated with increased risk of exacerbations and death. A substantial proportion of asthma patients have poor asthma control, and a concurrent COPD diagnosis often increases disease burden. The objective of the study was to describe the prevalence and managemant of severe asthma in a Swedish asthma popuöation. METHODS: In this observational cohort study, primary care medical records data (2006-2013) from 36 primary health care centers were linked to data from national mandatory Swedish health registries. The studied population (>18 years) had a record of drug collection for obstructive pulmonary disease (ATC code R03) during 2011-2012, and a physician diagnosed asthma (ICD-10 code J45-J46) prior to drug collection. Severe asthma was classified as collection of high dose inhaled steroid (> 800 budesonide or equivalent per day) and leukotriene receptor antagonist and/or long-acting beta-agonist. Poor asthma control was defined as either collection of ≥600 doses of short-acting beta-agonists, and/or ≥1 exacerbation(s) during the year post index date. RESULTS: A total of 18,724 asthma patients (mean 49 years, 62.8% women) were included, of whom 17,934 (95.8%) had mild to moderate and 790 (4.2%) had severe asthma. Exacerbations were more prevalent in severe asthma (2.59 [2.41-2.79], Relative Risk [95% confidence interval]; p < 0.001). Poor asthma control was observed for 28.2% of the patients with mild to moderate asthma and for more than half (53.6%) of the patients with severe asthma (<0.001). Prior to index, one in five severe asthma patients had had a contact with secondary care and one third with primary care. A concurrent COPD diagnosis increased disease burden. CONCLUSION: Severe asthma was found in 4.2% of asthma patients in Sweden, more than half of them had poor asthma control, and most patients had no regular health care contacts.

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4.2% of Swedish adult asthmatic patients in primary care settings have severe disease.
“For example, in has been reported that 4.2% of Swedish adult asthmatic patients in primary care settings have severe disease (36).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [36]

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ResultInfluential
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Result
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Background
Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study
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Background
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“21 However, the transition from pediatric to adult health care is an international concern, and we believe that our results can be transferred to other countries and populations.”
Result
Advances in respiratory physiology in mouse models of experimental asthma
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“Globally, around 3%–10% of asthma is classified as severe, which predominantly affects females (Busse et al., 2000; The ENFUMOSA cross, 2003; Larsson et al., 2018).”
Background
Association of Obesity and Severe Asthma in Adults
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Background
Discovery of the Oral Leukotriene C4 Synthase Inhibitor (1S,2S)-2-({5-[(5-Chloro-2,4-difluorophenyl)(2-fluoro-2-methylpropyl)amino]-3-methoxypyrazin-2-yl}carbonyl)cyclopropanecarboxylic Acid (AZD9898) as a New Treatment for Asthma
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Lee, H. J., Ryu, J., Chung, S. J., Park, D. W., Sohn, J. W., Yoon, H. J., & Kim, S. (2020) · Allergy Asthma and Immunology Research · doi:10.4168/aair.2020.12.5.821 · Cited by 23 · see citing works
Targeting of the IL-5 pathway in severe asthma reduces mast cell progenitors
Alvarado-Vazquez, P. A., Méndez-Enríquez, E., Salomonsson, M., Kopač, P., Koren, A., Bidovec‐Stojkovič, U., Škrgat, S., Simonson, O. E., Yasinska, V., Dahlén, S.-E., et al. (2024) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2024.10.025 · Cited by 20 · see citing works
“3,4 Importantly, severe asthma is associated with MC activation regardless of the etiology.”
Picturing asthma in Turkey: results from the Turkish adult asthma registry
Çelík, G., Aydın, Ö., Gokmen, D., Buhari, G. K., Sözener, Z. Ç., Gemicioğlu, B., Bulut, İ., Beyaz, Ş., Örçen, C., Özdemir, S. K., et al. (2023) · Journal of Asthma · doi:10.1080/02770903.2023.2206902 · Cited by 20 · see citing works
Pharmacological treatment of asthma in a cohort of adults during a 20-year period: results from the European Community Respiratory Health Survey I, II and III
Janson, C., Accordini, S., Cazzoletti, L., Cerveri, I., Chanoine, S., Corsico, A. G., Ferreira, D. S., García‐Aymerich, J., Gíslason, D., Nielsen, R., et al. (2019) · ERJ Open Research · doi:10.1183/23120541.00073-2018 · Cited by 20 · see citing works
What bothers severe asthma patients most? A paired patient–clinician study across seven European countries
Ainsworth, B., Chatburn, E., Bansal, A. T., Fulton, O., Hamerlijnck, D., Coleman, C., Eger, K. A. B., Hyland, M. E., Holmes, J., Heaney, L. G., et al. (2023) · ERJ Open Research · doi:10.1183/23120541.00717-2022 · Cited by 19 · see citing works
“Poorly controlled severe asthma remains common despite advances in treatment, especially the advent of biologics [11].”
Risk of Rehospitalization and Death in Patients Hospitalized Due to Asthma
Ekström, M. P., Nwaru, B. I., Wiklund, F., Telg, G., & Janson, C. (2020) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2020.12.030 · Cited by 19 · see citing works
Biologics in Severe Eosinophilic Asthma: Three-Year Follow-Up in a SANI Single Center
Solidoro, P., Nicola, S., Ridolfi, I., Canonica, G. W., Blasi, F., Paggiaro, P., Heffler, E. M., Bagnasco, D., Patrucco, F., Ribolla, F., et al. (2022) · Biomedicines · doi:10.3390/biomedicines10020200 · Cited by 18 · see citing works
“The mild or moderate form of the disease affects over 90% of asthmatics, while severe asthma (SA) affects about 5–10% of patients [2].”
Background
Optimizing asthma management: Role of long-acting muscarinic antagonists
Casale, T. B., Foggs, M. B., & Balkissoon, R. (2022) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2022.06.015 · Cited by 18 · see citing works
Integral Membrane Enzymes in Eicosanoid Metabolism: Structures, Mechanisms and Inhibitor Design
Thulasingam, M., & Haeggström, J. Z. (2020) · Journal of Molecular Biology · doi:10.1016/j.jmb.2020.07.020 · Cited by 18 · see citing works
The burden of adult asthma in Finland: impact of disease severity and eosinophil count on health care resource utilization
Viinanen, A., Lassenius, M. I., Toppila, I., Karlsson, A., Veijalainen, L., Idänpään-Heikkilä, J. J., & Laitinen, T. (2019) · Journal of Asthma · doi:10.1080/02770903.2019.1633664 · Cited by 16 · see citing works
High‐Dimensional Analysis of Type 2 Lymphocyte Dynamics During Mepolizumab or Dupilumab Treatment in Severe Asthma
Wirth, L. E., Weigel, W., Stamper, C. T., Kolmert, J., Ferreira, S. D. S., Hammer, Q., Mikus, M. S., Theorell, J., Andersson, L. I., Lantz, A., et al. (2025) · Allergy · doi:10.1111/all.16633 · Cited by 15 · see citing works
Adherence to inhaled corticosteroid therapy and treatment escalation in the Swedish adult asthma population
Packham, S., Ödling, M., Bossios, A., Konradsen, J. R., & Stridsman, C. (2024) · Respiratory Medicine · doi:10.1016/j.rmed.2024.107714 · Cited by 17 · see citing works
Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry
Takala, J., Ilmarinen, P., Tuomisto, L. E., Vähätalo, I., Niemelä, O. J., & Kankaanranta, H. (2020) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-020-0166-2 · Cited by 15 · see citing works
Prevalence of modifiable factors limiting treatment efficacy of poorly controlled asthma patients: EFIMERA observational study
Ribó, P., Molina, J., Rubio, M. C., Maiz, L., Campo, C., Rytilä, P. H., Plaza, V., & Valero, A. (2020) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-020-00189-6 · Cited by 14 · see citing works
Real-world treatment and health care resource use among severe asthma patients in Japan
To, Y., Taguchi, Y., Shimazaki, T., Arima, K., Yu, E., Demiya, S., & Iwanaga, T. (2021) · Respiratory Investigation · doi:10.1016/j.resinv.2021.02.010 · Cited by 14 · see citing works
Socioeconomic status is associated with healthcare seeking behaviour and disease burden in young adults with asthma – A nationwide cohort study
Håkansson, K. E. J., Backer, V., & Ulrik, C. S. (2022) · Chronic Respiratory Disease · doi:10.1177/14799731221117297 · Cited by 12 · see citing works
Infertility, pregnancy loss and assisted reproduction in women with asthma: a population-based cohort study
Jöud, A., Nilsson-Condori, E., Schmidt, L., Ziebe, S., Vassard, D., & Mattsson, K. (2022) · Human Reproduction · doi:10.1093/humrep/deac216 · Cited by 12 · see citing works
“This might also have led to underdiagnosing of active asthma, since reports have shown a low frequency of healthcare visits (compared to the recommended level) for patients with severe or uncontrolled asthma (Janson et al., 2018; Larsson et al., 2018).”
Result
MIA 2021, Manejo Integral del Asma. Lineamientos para México
Larenas‐Linnemann, D. E., Salas‐Hernandez, J., Del-Rio-Navarro, B. E., Luna-Pech, J. A., Navarrete-Rodriguez, E. M., Gochicoa‐Rangel, L., Cano-Salas, M. D. C., García‐Ramírez, U. N., López‐Estrada, E. D. C., Ortega‐Martell, J. A., et al. (2021) · Revista Alergia México · doi:10.29262/ram.v68i5.880 · Cited by 13 · see citing works
Feasibility and clinical applications of multiple breath wash-out (MBW) testing using sulphur hexafluoride in adults with bronchial asthma
Trinkmann, F., Lenz, S., Schäfer, J. C., Gawlitza, J. F., Schroeter, M., Gradinger, T., Akın, İ., Borggrefe, M., Ganslandt, T., & Saur, J. (2020) · Scientific Reports · doi:10.1038/s41598-020-58538-x · Cited by 12 · see citing works
NORDSTAR: paving the way for a new era in asthma research
Geale, K., Darabi, H., Lindh, M., Wahl, H. F., Ström, O., Cao, H., Alvares, L., Dodge, R., Loefroth, E., Altraja, A., et al. (2020) · European Respiratory Journal · doi:10.1183/13993003.02476-2019 · Cited by 12 · see citing works
“high use of inhaled corticosteroids and leukotriene receptor antagonists and/or LABA, have been used efficiently in recent large epidemiological studies [9, 26-28], revealing opportunities to study severe asthma patient group as well.”
Method
Using routinely collected primary care records to identify and investigate severe asthma: a scoping review
Stewart, J. E., Kee, F., & Hart, N. D. (2021) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-020-00213-9 · Cited by 11 · see citing works
Impact of reslizumab on outcomes of severe asthmatic patients: current perspectives
Galo, A. P., Labor, M., Tiotiu, A. I., Baiardini, I., Scichilone, N., & Braido, F. (2018) · Patient Related Outcome Measures · doi:10.2147/prom.s146966 · Cited by 11 · see citing works
“of life (HRQoL).(5) Although the prevalence of severe asthma is low, the burden of the disease on the patient, family, health care system, and society is disproportionally high, accounting for up to 30% of all costs incurred by all asthmatic patients.”
Annual and Post-Exacerbation Follow-Up of Asthma Patients in Clinical Practice – A Large Population-Based Study in Sweden
Sandelowsky, H., Ställberg, B., Wiklund, F., Telg, G., Licht, S. D. F., & Janson, C. (2022) · Journal of Asthma and Allergy · doi:10.2147/jaa.s357086 · Cited by 10 · see citing works
“The linked database was managed by the Department of Medical Sciences, Respiratory Medicine at Uppsala University, Sweden.”
ResultInfluential
A robust mRNA signature obtained via recursive ensemble feature selection predicts the responsiveness of omalizumab in moderate‐to‐severe asthma
Kidwai, S., Barbiero, P., Meijerman, I., Tonda, A. P., Perez‐Pardo, P., Lió, P., der Zee, A. H. M., Oberski, D. L., Kraneveld, A. D., & Lopez‐Rincon, A. (2023) · Clinical and Translational Allergy · doi:10.1002/clt2.12306 · Cited by 10 · see citing works
Prevalence of pre-existing lung diseases and their association with income level among patients with lung cancer: a nationwide population-based case-control study in South Korea
Oh, C., Lee, S. S., Kwon, H., Hwangbo, B., & Cho, H. (2023) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2023-001772 · Cited by 9 · see citing works
Coupling of spatial and directional functional network connectivity reveals a physiological basis for salience network hubs in asthma
Zhang, Y., Yang, Y., Xu, X., & Yuan, Y. (2021) · Brain Imaging and Behavior · doi:10.1007/s11682-021-00490-z · Cited by 9 · see citing works
Regional variation in intensity of inhaled asthma medication and oral corticosteroid use in Denmark, Finland, and Sweden
Lehtimäki, L. A., Arvidsson, M., Erdemli, B., Nan, C., Nguyen, T.-M., Samant, A., & Telg, G. (2022) · European Clinical Respiratory Journal · doi:10.1080/20018525.2022.2066815 · Cited by 8 · see citing works
“6%) have poorly controlled asthma [12]; by comparison, an estimated 8.”
BackgroundInfluential
Small airways targeted treatment with smart nebulizer technology could improve severe asthma in children: a retrospective analysis
van den Bosch, W. B., Kloosterman, S. F., Andrinopoulou, E., Greidanus, R., Pijnenburg, M. W. H., Tiddens, H. A. W. M., & Janssens, H. M. (2021) · Journal of Asthma · doi:10.1080/02770903.2021.1996597 · Cited by 8 · see citing works
Participation in scheduled asthma follow-up contacts and adherence to treatment during 12-year follow-up in patients with adult-onset asthma
Takala, J., Vähätalo, I., Tuomisto, L. E., Niemelä, O. J., Ilmarinen, P., & Kankaanranta, H. (2022) · BMC Pulmonary Medicine · doi:10.1186/s12890-022-01850-1 · Cited by 8 · see citing works
“Our results are in line with previous studies [9, 16, 32, 33], showing that frequent scheduled contacts were not associated with asthma control and that patients with more symptomatic asthma participated more regularly in follow-up and used more health care services.”
Result
Detection and prediction of real-world severe asthma phenotypes by application of machine learning to electronic health records
Bagci, M. F., Do, T., Bagsic, S. R. S., Gomez, R. F., JUN, J., Ritko, A. L., Wenzel, S. E., Nguyen, T. Q., Öztürk, Y., & Modena, B. D. (2025) · Journal of Allergy and Clinical Immunology Global · doi:10.1016/j.jacig.2025.100473 · Cited by 7 · see citing works
“28,29 However, similar to prior studies, 27,30 using the ATS guidelines deﬁnition of >_2 oral steroid courses (>3 days) with guidelines-suggested medications for GINA step 4-5 asthma, our analysis indicated that many patients diagnosed with mild-to-moderate asthma likely had SA.”
Patient perspectives on living with severe asthma in Denmark and Sweden
Papapostolou, G., Tunsäter, A., Binnmyr, J., Telg, G., & Roslind, K. (2020) · European Clinical Respiratory Journal · doi:10.1080/20018525.2020.1856024 · Cited by 7 · see citing works
“Patients with severe asthma who do not achieve asthma control with inhaled treatments, such as inhaled corticosteroids and long-acting bronchodilators, are often prescribed oral corticosteroids (OCS), both as short-term treatment for exacerbations and as longterm medication to maintain asthma control [6].”
Background
Severe Asthma or Chronic Obstructive Pulmonary Disease with Eosinophilic Inflammation? From Uncertainty to Remission under Anti IL-5R Therapy
Oprescu, B., Rădună, O., Mihaicuta, S. D., & Frent, S. (2024) · Medicina · doi:10.3390/medicina60030387 · Cited by 6 · see citing works
“Data on the prevalence of severe asthma are sparse, but reports indicate that between 5 and 10% of the asthmatic population has severe disease [4].”
Background
Impact of the Asthma Quality Assessment Program on Burden of Asthma
Park, H. J., Kim, S., Kim, S., Lee, H. S., Kim, B., Kim, H., Ahn, S. I., Shin, J. H., Lee, J., & Park, J. (2020) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2020.08.038 · Cited by 6 · see citing works
Biologics in asthma management – Are we out of breath yet?
Struß, N., & Hohlfeld, J. M. (2021) · Allergologie select · doi:10.5414/alx02192e · Cited by 6 · see citing works
“2% [4], respectively, of all asthmatics studied.”
Overcoming Barriers to the Effective Management of Severe Asthma in Italy
Paggiaro, P., Barbaglia, S., Centanni, S., Croce, D., Desideri, E., Giustini, S. E., Micheletto, C., Musarra, A., Scichilone, N., Trama, U., et al. (2021) · Journal of Asthma and Allergy · doi:10.2147/jaa.s293380 · Cited by 6 · see citing works
Maternal asthma and early fetal growth, the MAESTRO study
Rejnö, G., Lundholm, C., Saltvedt, S., Larsson, K., & Almqvist, C. (2021) · Clinical & Experimental Allergy · doi:10.1111/cea.13864 · Cited by 5 · see citing works
Trichinella spiralis-derived extracellular vesicles induce regulatory T cells and reduce airway allergy in mice
Glamočlija, S., Sabljić, L., Schmid, A. M., Ilić, N., Gruden‐Movsesijan, A., Vasilev, S., Inić‐Kanada, A., Wiedermann, U., Schabussová, I., & Kosanović, M. (2025) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1637569 · Cited by 4 · see citing works
Trends in pediatric hospitalizations for ambulatory care sensitive respiratory diseases in Brazil
Carneiro, V. S. M., Vila, V. D. S. C., & Vieira, M. A. (2020) · Public Health Nursing · doi:10.1111/phn.12818 · Cited by 4 · see citing works
Documentation of comorbidities, lifestyle factors, and asthma management during primary care scheduled asthma contacts
Takala, J., Vähätalo, I., Tuomisto, L. E., Niemelä, O. J., Ilmarinen, P., & Kankaanranta, H. (2024) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-024-00360-3 · Cited by 4 · see citing works
“Annual follow-up reviews do not, unfortunately, occur often according to guidelines 21 – 24 , even in severe asthma 25,26 , that is shown to be underdiagnosed in primary health care (PHC) 27 .”
Short Acting Beta Agonist Use Associated with Increased Mortality and Morbidity in Asthma Patients: A Systematic Review and Meta-Analysis
Hu, Y., Kung, J. Y. C., Galatis, D., & Banh, H. L. (2022) · Journal of Pharmacy & Pharmaceutical Sciences · doi:10.18433/jpps32738 · Cited by 3 · see citing works
“Studies also showed that persistent use of SABA did not prompt the health care professionals to make changes to the asthma management (26-27).”
Background
Trends and predictors of specialist assessments in oral corticosteroid treated asthma among young adults
Skov, I. R., Madsen, H., Andersen, J. H., Pottegård, A., & Davidsen, J. R. (2022) · ERJ Open Research · doi:10.1183/23120541.00142-2022 · Cited by 3 · see citing works
“2%) (n<5) Years since first asthma drug dispensing (any time before index date), median (IQR) 7 (4-13) 9 (4-14) 7 (4-12) <0.”
Background
Case Report: Extending dosing intervals of biologics in adults severe asthma: a case series
Harada, T., Nishigami, M., Tanaka, H., Inui, G., Ishikawa, H., Kohno, H., Funaki, Y., Sakamoto, T., Takata, M., Okazaki, R., et al. (2026) · Frontiers in Allergy · doi:10.3389/falgy.2025.1635540 · Cited by 2 · see citing works
Anti-aminoacyl-tRNA synthetase-interacting multifunctional protein-1 antibody improves airway inflammation in mice with house dust mite induced asthma
Kim, S., Um, Y. J., Chung, S. I., Jeong, K. Y., Park, H. J., Park, K., Park, J., Park, S. G., & Lee, J. (2024) · World Allergy Organization Journal · doi:10.1016/j.waojou.2024.100956 · Cited by 2 · see citing works
“5 , 6 9 Therefore, several biologics have been developed for the treatment of severe asthma.”
Background
Factors influencing the prescription of add-on long-acting muscarinic antagonists in real-world asthma management: Insights from a national registry
Gemicioğlu, B., Gokmen, D., Can, A., Sevinç, C., Oğuzülgen, İ. K., Soyyiğit, Ş., Yakut, T., Havlucu, Y., Aydın, Ö., Buhari, G. K., et al. (2024) · Respiratory Medicine · doi:10.1016/j.rmed.2024.107883 · Cited by 2 · see citing works
The Epidemiology of Severe Childhood Asthma
Čustović, A., & Martínez, F. D. (2019) · Springer eBooks · doi:10.1007/978-3-030-27431-3_1 · Cited by 2 · see citing works
Identifying and addressing health inequalities in asthma care
Ryan, D. P., & Sabroe, I. (2021) · European Respiratory Journal · doi:10.1183/13993003.01829-2021 · Cited by 2 · see citing works
Prevalence, Management, and Treatment of Pediatric Acute Asthma in the Emergency Department: A Descriptive Cross-sectional Study in Zahedan, Iran (2023)
Ghadimi, Z. S., Miri, A., Assadi, Z., Mohammadi, M., & Teimouri, A. (2025) · Zahedan Journal of Research in Medical Sciences · doi:10.5812/zjrms-162520 · Cited by 1 · see citing works
Estimating the financial burden of asthma among young adults in Sweden
Rovsing, A. H., Ssegonja, R., Janson, C., Løkke, A., Ibsen, R., Hilberg, O., Backer, V., Ulrik, C. S., Weinreich, U. M., & Håkansson, K. E. J. (2025) · European Clinical Respiratory Journal · doi:10.1080/20018525.2025.2569135 · Cited by 1 · see citing works
“With an estimated asthma prevalence of 10.9–12.2%, a high proportion of patients with poor disease control, and a low prevalence of ICS-treated asthma, Sweden has a relatively high asthma burden [10–12].”
Influential
Asthma/COPD clinics increases adherence to management guidelines and associates with less morbidity and lower all-cause mortality – a prospective cohort study
Nilsson, J. L. G., Bäckman, H., Sundbaum, J. K., Strandkvist, V. J., Hedman, L., & Stridsman, C. (2026) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-026-00497-3 · Cited by 1 · see citing works
“%) were seen in another study, albeit with higher rates in patients with severe asthma 51 .”
Characterization of Austrian severe asthma patients
Renner, A., Stoshikj, S., Pohl, W., Bal, C., Reisinger, M., Löffler‐Ragg, J., Zacharasiewicz, A. S., Buhl, R., Hamelmann, E. H., Taube, C., et al. (2023) · Respiratory Medicine · doi:10.1016/j.rmed.2023.107427 · Cited by 1 · see citing works
Predicting Response to Group Cognitive Behavioral Therapy in Asthma by a Small Number of Abnormal Resting-State Functional Connections
Zhang, Y., Ma, K., Yang, Y., Yin, Y., Hou, Z., Zhang, D., & Yuan, Y. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.575771 · Cited by 1 · see citing works
The Impact of Socioeconomic Risk Factors and Mental Health on Asthma.
Le, T. P., Sutherlin, T. K., Teverbaugh, L. A., Gleason, M., & Carlson, J. (2021) · Annals of Allergy, Asthma & Immunology · doi:10.1016/j.anai.2021.02.014
Event dependent overall survival in the population-based LIFE-Adult-Study
Zeynalova, S., Rillich, K., Linnebank, E., Stegmann, T., Brosig, M., Reusche, M., & Loeffler, M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0278069 · Cited by 1 · see citing works
Efeito da reabilitação pulmonar aliado à capacidade funcional e função ventilatória de asmáticos
Ywmamoto, L. S., Oliveira, D. V., Antunes, M. D., Júnior, J. R. A. N., Bueno, G. R., & Cappellazo, R. (2020) · Saúde e Desenvolvimento Humano · doi:10.18316/sdh.v8i2.6262
Relationship between pulmonary function tests, sputum eosinophilia and total serum IgE levels among asthmatic patients in Duhok, Iraq
Issa, H. Y., Ramadhan, A. A., Safo, A., & Habib, O. (2020) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20202239
“Most patients with asthma have a mild or moderate disease and data on the prevalence of severe asthma is sparse but reports indicate between 5 and 10% of the asthmatic populations to have had severe disease.(23) In this study, the method used for classifying asthma severity incorporated patient’s symptoms into pulmona…”
Method
THE CORRELATION OF SYMPTOMS AND OBJECTIVE WHEEZE IN ASTHMATICS
Khattak, A. L., Khan, M. K., Naz, S., Kashif, N., Shah, S. K. H., & Ibrahim, M. T. (2020) · Pakistan Armed Forces Medical Journal · doi:10.51253/pafmj.v70i6.4736
Role of Common Variables: Age, Gender, BMI, Rhinosinusitis, and Smoking among Asthmatic and Severe Asthmatic Patients.
Masjedi, M. R., Ainy, E., Fakharian, A., Eslaminejad, A., & Paydar, R. (2020) · PubMed Central
FACTORS RESTRICT TREATMENT EFFICIENCY IN ASTHMA PATIENTS
Hassan, K. (2021) · International Journal of Medical and Biomedical Studies · doi:10.32553/ijmbs.v5i9.2183
“Spirometry and a bronchodilator test were performed on all patients to confirm or rule out asthma [19-24].”
Method
PREVALENCE OF THERAPEUTIC INERTIA AND ITS ASSOCIATED FACTORS AMONG PATIENTS ON BRONCHIAL ASTHMA MANAGEMENT IN A REFERRAL TEACHING HOSPITAL IN SOUTHWEST ETHIOPIA, 2023: A CROSS-SECTIONAL STUDY.
Lake, G. A., Yoo, S. D. J., Disasa, G. M., & Temesgen, T. A. (2023) · Student s Journal of Health Research Africa · doi:10.51168/sjhrafrica.v4i12.898
Head-to-Head Effectiveness Comparison of Biological Therapies in Patients With Mixed Eosinophilic and Allergic Severe Asthma
Sánchez, J., Álvarez, L., Caraballo, A.-L., Santamaría-Salazar, L. C., Acevedo, A.-M., Calle, A., & Olivares, M. (2025) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2025.03.035
Efficacy of biologic therapy in patients with severe occupational and work-related asthma
Shpagina, L. A., Сергеевна, К. О., Шпагин, И. С., Kuznetsova, G. V., Александровна, К. С., Kondyurina, E. G., Zelenskaya, V. V., Kamneva, N. V., Sergeev, V. A., & Makarov, K. Y. (2025) · PULMONOLOGIYA · doi:10.18093/0869-0189-2025-35-5-635-645
Characteristics of severe asthma patients with biologic treatment in the Swedish National Airway Register
Sundbom, F., Stridsman, C., Palm, A., Emilsson, Ö. I., & Janson, C. (2025) · European Clinical Respiratory Journal · doi:10.1080/20018525.2026.2707771
“The majority of all asthma patients present with mild to moderate disease, but approximately 5–10% of individuals with asthma in Sweden are affected by severe asthma [1,2].”
Characteristics and management of patients attending primary asthma clinics in primary health care in the Kingdom of Bahrain: A cross-sectional study
Jerdabi, F. A., Alawainati, M., Al-Saweer, A., Arafat, F. A., Alhalwaji, M., Sharaf, E. S. M., & Aradi, L. A. (2025) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_24_25
“[29] ’s report, this study found that most participants had mild to moderate asthma (32.9% and 52.0%, respectively).”
Influential
Additional file 1 of Participation in scheduled asthma follow-up contacts and adherence to treatment during 12-year follow-up in patients with adult-onset asthma
Takala, J., Vähätalo, I., Tuomisto, L. E., Niemelä, O. J., Ilmarinen, P., & Kankaanranta, H. (2022) · Figshare · doi:10.6084/m9.figshare.19220935
Acute Bronchiolitis in Young Children and Future Mental Health Outcome: A 15‐Year National Population Study Regardless of Allergic Conditions
Kim, J. H., Shin, J., Ha, E. K., Han, B. E., & Han, H. Y. (2026) · Pediatric Pulmonology · doi:10.1002/ppul.71494
“X) as the primary diagnosis [17].”
Characteristics of Adult Severe Uncontrolled Asthma Patients in Primary Care and Modifications in Prescribed Inhalation Treatments
Konradsen, J. R., Packham, S., Vanfleteren, L. E. G. W., Syk, J., Bossios, A., & Stridsman, C. (2026) · Journal of Asthma and Allergy · doi:10.2147/jaa.s585933
“7,8 Severe uncontrolled asthma was associated with female sex, obesity, current smoking, and depression.”
Disrupted variance in respiratory illness presentation patterns in New Zealand primary care through and after the SARS-CoV-2 pandemic: an observational cohort study using automated mining of electronic health records and clinical text
Dowell, A. C., MacRae, J., Blanch, R., Hiroi, M., Castelino, L., & Turner, N. M. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-103176
A prospective observational study to evaluate the prevalence of severe asthma among subjects with difficult-to-treat asthma at a tertiary care center in North India
Sharma, S., Agarwal, R., Muthu, V., Rudramurthy, S. M., Kumar, Y., Prabhakar, N., Sehgal, I. S., Dhooria, S., Aggarwal, A. N., & Prasad, K. T. (2026) · Lung India · doi:10.4103/lungindia.lungindia_751_25
Provision of biologic therapy for severe asthma and chronic obstructive pulmonary disease: an analysis of data from 51 regions of the Russian Federation
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Features of severe asthma in primary care – an observational study
Telg, G., Larsson, K., Ställberg, B., Lisspers, K., Johansson, G. S., Janson, C., & Thuresson, M. (2017) · doi:10.1183/1393003.congress-2017.pa1601 · Cited by 1 · see citing works
Characteristics and treatment escalation of severe uncontrolled asthma patients in primary care in Sweden
Konradsen, J. R., Packham, S., Syk, J., Bossios, A., & Stridsman, C. (2024) · doi:10.1183/13993003.congress-2024.pa743
Asthma in Primary Care : Severity, Treatment and Level of Control
Ställberg, B. (2008) · Uppsala University Publications (Uppsala University)
Prevalence of Severe Asthma and Poorly Controlled Severe Asthma During 2009–2013 in The Netherlands
Smits, E., Overbeek, J., Valgardsson, V., Laer, J. V., & Beest, F. P.-V. (2016) · Value in Health · doi:10.1016/j.jval.2016.09.1175
The prevalence of severe asthma and low asthma control among Danish adults
von Bülow, A., Kriegbaum, M., Backer, V., & Porsbjerg, C. (2014) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2014.05.005 · Cited by 154 · see citing works

Authors: Larsson, K., Ställberg, B., Lisspers, K., Telg, G., Johansson, G., Thuresson, M., & Janson, C.
Affiliations: Karolinska Institutet (SE)
Uppsala University (SE)
AstraZeneca (Sweden) (SE)
Statisticon (Sweden) (SE)
Corresponding author: Larsson, Kjell
ORCID: Larsson, Kjell
Ställberg, Björn
Lisspers, Karin
Telg, Gunilla
Johansson, Gunnar
Thuresson, Marcus
Janson, Christer
Venue: Respiratory Research
Publisher: Springer Science and Business Media LLC
Published: 2018-01-18
Volume: 19
Issue: 1
Pages: 12-12
ISSN: 1465-9921 (ISSN-L)
1465-993X
DOI: 10.1186/s12931-018-0719-x
PMC: PMC5774144
OpenAlex: W2794020024
Cited by: 100
References: 27
Citations by year: 2026: 7 · 2025: 9 · 2024: 8 · 2023: 8 · 2022: 13 · 2021: 13 · 2020: 26 · 2019: 12 · 2018: 4
FWCI: 9.60
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: Respiratory Research (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: AstraZeneca
Topics: Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
Keywords: severe asthma, asthma prevalence, asthma control, asthma exacerbations, COPD comorbidities, primary care, asthma management, inhaled corticosteroids, leukotriene receptor antagonists, long-acting beta2-agonists, short-acting beta2-agonists, health care utilization, disease burden
MeSH terms: Adult, Aged, Aged, 80 and over, Asthma, Female, Humans, Male, Middle Aged, Primary Health Care, Registries, Severity of Illness Index, Sweden, Cohort Studies, Prevalence, Anti-Asthmatic Agents, Disease Management

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Prevalence and management of severe asthma in primary care: an observational cohort study in Sweden (PACEHR)

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