{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T08:42:23Z","timestamp":1761986543342},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T00:00:00Z","timestamp":1591660800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T00:00:00Z","timestamp":1591660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background: Severe asthma (SA) database was established in Hungary to estimate the prevalence of SA and to define and analyze clinical phenotypes of the patients. Methods: SA questionnaires were sent out to 143 public pulmonary dispensaries specialized for diagnosing and caring pulmonary patients. Data of 520 SA patients were evaluated. Results: The prevalence of SA within the asthmatic population in Hungary was 0.89%. The mean age of patients were 56.4\u2009\u00b1\u200913.4 years, SA were more frequent in females (64%), the prevalence of allergy was 56.6%, 72.1% of patients had persistent airflow limitation (FEV1\u2009&lt;\u200980%), 37.9% severe airway obstruction (FEV1\u2009\u2264\u200960%), 33.6% required systemic corticosteroid maintenance therapy, 21.5% had salicylate intolerance and 43.2% rhinosinusitis. A Bayesian dependency network was calculated which revealed several interdependencies between the characteristics. E.g. there was a strong association between salicylate intolerance and rhinosinusitis, more patients received regular systemic corticosteroid treatment who had salicylate intolerance and the proportion of salicylate intolerance was significantly higher in females. Conclusion: The prevalence of SA was determined in Hungary which was lower than in other studies. Using a Bayesian-based network analysis several interdependencies were revealed between patient characteristics.<\/jats:p>","DOI":"10.1038\/s41598-020-66445-4","type":"journal-article","created":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T10:02:46Z","timestamp":1591696966000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence and characterization of severe asthma in Hungary"],"prefix":"10.1038","volume":"10","author":[{"given":"Zsuzsanna","family":"Csoma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zs\u00f3fia","family":"G\u00e1l","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e1s","family":"G\u00e9zsi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ir\u00e9n","family":"Herjavecz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Csaba","family":"Szalai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,6,9]]},"reference":[{"key":"66445_CR1","first-page":"848","volume":"22","author":"B Chastek","year":"2016","unstructured":"Chastek, B. et al. Economic burden of illness among patients with severe asthma in a managed care setting. J. Manag. Care Spec. Pharm. 22, 848\u2013861 (2016).","journal-title":"J. Manag. Care Spec. Pharm."},{"key":"66445_CR2","doi-asserted-by":"publisher","first-page":"657","DOI":"10.3109\/02770909809048968","volume":"35","author":"SC Tough","year":"1998","unstructured":"Tough, S. C. et al. Features that distinguish those who die from asthma from community controls with asthma. J. Asthma 35, 657\u2013665 (1998).","journal-title":"J. Asthma"},{"key":"66445_CR3","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1111\/j.1365-2796.2012.02558.x","volume":"272","author":"M Kupczyk","year":"2012","unstructured":"Kupczyk, M. & Wenzel, S. US and European severe asthma cohorts: What can they teach us about severe asthma? Journal of Internal Medicine 272, 121\u2013132 (2012).","journal-title":"Journal of Internal Medicine"},{"key":"66445_CR4","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1016\/S0140-6736(08)61452-X","volume":"372","author":"GP Anderson","year":"2008","unstructured":"Anderson, G. P. Endotyping asthma: new insights into key pathogenic mechanisms in a complex, heterogeneous disease. The Lancet 372, 1107\u20131119 (2008).","journal-title":"The Lancet"},{"key":"66445_CR5","first-page":"470","volume":"22","author":"ENFUMOSA Study Group.","year":"2003","unstructured":"ENFUMOSA Study Group. The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma. European Network for Understanding Mechanisms of Severe Asthma. Eur. Respir. J. 22, 470\u20137 (2003).","journal-title":"European Network for Understanding Mechanisms of Severe Asthma. Eur. Respir. J."},{"key":"66445_CR6","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/S1081-1206(10)61707-3","volume":"92","author":"CM Dolan","year":"2004","unstructured":"Dolan, C. M. et al. Design and baseline characteristics of The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study: A large cohort of patients with severe or difficult-to-treat asthma. Ann. Allergy, Asthma Immunol. 92, 32\u201339 (2004).","journal-title":"Ann. Allergy, Asthma Immunol."},{"key":"66445_CR7","unstructured":"Research and Innovation - European Commission. Available at: http:\/\/ec.europa.eu\/research\/quality-of-life\/ka4\/pdf\/report_bioair_en.pdf. (Accessed: 20th January 2020)."},{"key":"66445_CR8","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.jaci.2006.11.639","volume":"119","author":"WC Moore","year":"2007","unstructured":"Moore, W. C. et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute\u2019s Severe Asthma Research Program. J. Allergy Clin. Immunol. 119, 405\u2013413 (2007).","journal-title":"J. Allergy Clin. Immunol."},{"key":"66445_CR9","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1136\/thx.2010.153643","volume":"66","author":"EH Bel","year":"2011","unstructured":"Bel, E. H. et al. Diagnosis and definition of severe refractory asthma: An international consensus statement from the innovative medicine initiative (IMI). Thorax 66, 910\u2013917 (2011).","journal-title":"Thorax"},{"key":"66445_CR10","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1183\/09031936.00202013","volume":"43","author":"KF Chung","year":"2014","unstructured":"Chung, K. F. et al. International ERS\/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur. Respir. J. 43, 343\u2013373 (2014).","journal-title":"Eur. Respir. J."},{"key":"66445_CR11","unstructured":"Global Initiative For Asthma. A GINA Pocket Guide For Health Professionals: Difficult-To-Treat & Severe asthma in adolescent and adult patients-Diagnosis and Management. (2019)."},{"key":"66445_CR12","doi-asserted-by":"crossref","unstructured":"Larsson, K. et al. Prevalence and management of severe asthma in primary care: An observational cohort study in Sweden (PACEHR). Respir. Res. 19 (2018).","DOI":"10.1186\/s12931-018-0719-x"},{"key":"66445_CR13","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/j.jaci.2014.08.042","volume":"135","author":"PPW Hekking","year":"2015","unstructured":"Hekking, P. P. W. et al. The prevalence of severe refractory asthma. J. Allergy Clin. Immunol. 135, 896\u2013902 (2015).","journal-title":"J. Allergy Clin. Immunol."},{"key":"66445_CR14","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.alit.2019.06.003","volume":"69","author":"H Nagase","year":"2020","unstructured":"Nagase, H. et al. Prevalence, disease burden, and treatment reality of patients with severe, uncontrolled asthma in Japan. Allergol. Int. 69, 53\u201360 (2020).","journal-title":"Allergol. Int."},{"key":"66445_CR15","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.rmed.2018.10.002","volume":"144","author":"C Nordon","year":"2018","unstructured":"Nordon, C. et al. Clinical and economic burden of severe asthma: A French cohort study. Respir. Med. 144, 42\u201349 (2018).","journal-title":"Respir. Med."},{"key":"66445_CR16","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/j.jaip.2014.05.005","volume":"2","author":"A von B\u00fclow","year":"2014","unstructured":"von B\u00fclow, A., Kriegbaum, M., Backer, V. & Porsbjerg, C. The Prevalence of Severe Asthma and Low Asthma Control Among Danish Adults. J. Allergy Clin. Immunol. Pract. 2, 759\u2013767 (2014).","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"66445_CR17","doi-asserted-by":"crossref","unstructured":"van Bragt, J. J. M. H. et al. Characteristics and treatment regimens across ERS SHARP severe asthma registries. Eur. Respir. J. 55 (2020).","DOI":"10.1183\/13993003.01163-2019"},{"key":"66445_CR18","doi-asserted-by":"crossref","unstructured":"Altman, D. G. Practical statistics for medical research. Statistics in Medicine 10, (Chapman and Hall (1991).","DOI":"10.1201\/9780429258589"},{"key":"66445_CR19","doi-asserted-by":"crossref","unstructured":"Mistry, H. et al. Does early-onset difficult asthma in adulthood differ by sex? Findings from WATCH. in ERS International Congress 52, PA1088 (European Respiratory Society (ERS) (2018).","DOI":"10.1183\/13993003.congress-2018.PA1088"},{"key":"66445_CR20","doi-asserted-by":"publisher","unstructured":"Antal, P. et al. A bioinformatic platform for a bayesian, multiphased, multilevel analysis in immunogenomics. in Bioinformatics for immunomics (eds. Flower, D. R. & Davies, M, R. S.) 157\u2013185 (Springer. https:\/\/doi.org\/10.1007\/978-1-4419-0540-6_11 (2010).","DOI":"10.1007\/978-1-4419-0540-6_11"},{"key":"66445_CR21","doi-asserted-by":"crossref","unstructured":"Ungv\u00e1ri, I. et al. Evaluation of a partial genome screening of two asthma susceptibility regions using bayesian network based bayesian multilevel analysis of relevance. PLoS One 7, (2012).","DOI":"10.1371\/journal.pone.0033573"},{"key":"66445_CR22","doi-asserted-by":"crossref","unstructured":"Lautner-Csorba, O. et al. Candidate gene association study in pediatric acute lymphoblastic leukemia evaluated by Bayesian network based Bayesian multilevel analysis of relevance. BMC Med. Genomics 5 (2012).","DOI":"10.1186\/1755-8794-5-42"},{"key":"66445_CR23","doi-asserted-by":"crossref","unstructured":"Wenzel, S. E. et al. Proceedings of the ATS workshop on refractory asthma: Current understanding, recommendations, and unanswered questions. In American Journal of Respiratory and Critical Care Medicine 162, 2341\u20132351 (American Lung Association (2000).","DOI":"10.1164\/ajrccm.162.6.ats9-00"},{"key":"66445_CR24","unstructured":"Global Initiative For Asthma. Global Strategy for Asthma Management and Prevention. Available at: https:\/\/ginasthma.org\/wp-content\/uploads\/2019\/06\/GINA-2019-main-report-June-2019-wms.pdf. (Accessed: 6th January 2020) (2019)."},{"key":"66445_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2011\/861926","volume":"2011","author":"AA Zeki","year":"2011","unstructured":"Zeki, A. A., Schivo, M., Chan, A., Albertson, T. E. & Louie, S. The Asthma-COPD Overlap Syndrome: A Common Clinical Problem in the Elderly. J. Allergy 2011, 1\u201310 (2011).","journal-title":"J. Allergy"},{"key":"66445_CR26","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1111\/j.1365-2222.2012.03977.x","volume":"42","author":"M Amelink","year":"2012","unstructured":"Amelink, M. et al. Non-atopic males with adult onset asthma are at risk of persistent airflow limitation. Clin. Exp. Allergy 42, 769\u2013774 (2012).","journal-title":"Clin. Exp. Allergy"},{"key":"66445_CR27","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1164\/rccm.201107-1317PP","volume":"185","author":"NN Jarjour","year":"2012","unstructured":"Jarjour, N. N. et al. Severe asthma: Lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program. American Journal of Respiratory and Critical Care Medicine 185, 356\u2013362 (2012).","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"key":"66445_CR28","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1016\/j.rmed.2014.10.007","volume":"108","author":"F Schleich","year":"2014","unstructured":"Schleich, F. et al. Heterogeneity of phenotypes in severe asthmatics. The Belgian Severe Asthma Registry (BSAR). Respir. Med. 108, 1723\u20131732 (2014).","journal-title":"Respir. Med."},{"key":"66445_CR29","first-page":"45","volume":"7","author":"K Li","year":"2019","unstructured":"Li, K., Lee, A. & Abuzeid, W. Aspirin Exacerbated Respiratory Disease: Epidemiology, Pathophysiology, and Management. Med. Sci. 7, 45 (2019).","journal-title":"Med. Sci."},{"key":"66445_CR30","unstructured":"Herjavecz, I. & B\u00f6sz\u00f6rm\u00e9nyi Nagy, G. Provocation tests with salicylate and food additives in patients with non-allergic asthma. In International Union of Physiological Sciences XIV., 470 (1980)."},{"key":"66445_CR31","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1136\/thx.2010.137414","volume":"65","author":"LG Heaney","year":"2010","unstructured":"Heaney, L. G., Brightling, C. E., Menzies-Gow, A., Stevenson, M. & Niven, R. M. Refractory asthma in the UK: Cross-sectional findings from a UK multicentre registry. Thorax 65, 787\u2013794 (2010).","journal-title":"Thorax"},{"key":"66445_CR32","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.4049\/jimmunol.1800293","volume":"201","author":"H Fuseini","year":"2018","unstructured":"Fuseini, H. et al. Testosterone Decreases House Dust Mite\u2013Induced Type 2 and IL-17A\u2013Mediated Airway Inflammation. J. Immunol. 201, 1843\u20131854 (2018).","journal-title":"J. Immunol."},{"key":"66445_CR33","doi-asserted-by":"publisher","first-page":"2487","DOI":"10.1016\/j.celrep.2017.10.110","volume":"21","author":"JY Cephus","year":"2017","unstructured":"Cephus, J. Y. et al. Testosterone Attenuates Group 2 Innate Lymphoid Cell-Mediated Airway Inflammation. Cell Rep. 21, 2487\u20132499 (2017).","journal-title":"Cell Rep."},{"key":"66445_CR34","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1038\/nm.2678","volume":"18","author":"SE Wenzel","year":"2012","unstructured":"Wenzel, S. E. Asthma phenotypes: The evolution from clinical to molecular approaches. Nature Medicine 18, 716\u2013725 (2012).","journal-title":"Nature Medicine"},{"key":"66445_CR35","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.jaci.2003.10.041","volume":"113","author":"C Miranda","year":"2004","unstructured":"Miranda, C., Busacker, A., Balzar, S., Trudeau, J. & Wenzel, S. E. Distinguishing severe asthma phenotypes: Role of age at onset and eosinophilic inflammation. J. Allergy Clin. Immunol. 113, 101\u2013108 (2004).","journal-title":"J. Allergy Clin. Immunol."},{"key":"66445_CR36","doi-asserted-by":"crossref","unstructured":"Chipps, B. E. et al. Key findings and clinical implications from the Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J. Allergy Clin. Immunol. 130 (2012).","DOI":"10.1016\/j.jaci.2012.04.014"},{"key":"66445_CR37","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1034\/j.1399-3003.2000.016003432.x","volume":"16","author":"A Szczeklik","year":"2000","unstructured":"Szczeklik, A., Nizankowska, E. & Duplaga, M. Natural history of aspirin-induced asthma. AIANE Investigators. European Network on Aspirin-Induced Asthma. Eur. Respir. J. 16, 432\u20136 (2000).","journal-title":"Eur. Respir. J."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-66445-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-66445-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-66445-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T11:58:05Z","timestamp":1670327885000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-66445-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,9]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["66445"],"URL":"https:\/\/doi.org\/10.1038\/s41598-020-66445-4","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,9]]},"assertion":[{"value":"19 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"9274"}}