{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T15:46:19Z","timestamp":1769096779064,"version":"3.49.0"},"reference-count":33,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T00:00:00Z","timestamp":1663545600000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>In Portugal as in other countries, data on the epidemiology of asthma are mainly grounded in questionnaire studies. Additionally, the detailed characterisation of asthma in terms of disease severity, control and phenotypes remain scarce. Studies assessing the prevalence of asthma and its subgroups using accurate methods are needed. This study aims to determine the prevalence of asthma, difficult-to-treat asthma and severe asthma, and to evaluate sociodemographic and clinical characteristics of those patients, in mainland Portugal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and analysis<\/jats:title><jats:p>A population-based nationwide study with a multicentre stepwise approach will be conducted between 2021 and 2023 in 38 primary care centres of the Portuguese National Health Service. The stepwise approach will comprise four stages: Stage 0\u2014telephone call invitation to adult subjects (\u226518 years) randomly selected (n~15\u2009000); stage 1\u2014telephone screening interview assessing the participants\u2019 respiratory symptoms (n~7500); stage 2\u2014diagnostic visit, including physical examination, diagnostic tests (eg, spirometry, fraction of exhaled nitric oxide, blood eosinophil count) and patient-reported outcome measures for diagnostic confirmation of those identified with possible asthma at stage 1 (n~1800); stage 3\u2014further evaluation of patients with asthma and of patients with difficult-to-treat asthma and severe asthma, after 3 months (n~460). At stage 3, data will be collected from a review of the patient\u2019s electronic health records, a follow-up telephone call and the CARATm (Caracteristicas Auto-reportadas de Asma em Tecnologias M\u00f3veis) app database. The prevalence of asthma, difficult-to-treat asthma and severe asthma will be determined as the percentage of patients with asthma confirmed from the overall population (stage 1). For the analysis of factors associated with asthma, difficult-to-treat asthma and severe asthma, logistic regression models will be explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ethics and dissemination<\/jats:title><jats:p>Ethical approvals for the study were obtained from the ethics committee of the local health unit of Matosinhos, Porto (38\/CES\/JAS), Alto Minho (38\/2021\/CES) and the regional health administration of Lisbon-Vale do Tejo (035\/CES\/INV\/2021). Results will be published in peer-reviewed journals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05169619\">NCT05169619<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-064538","type":"journal-article","created":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T17:11:28Z","timestamp":1663607488000},"page":"e064538","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["EPI-ASTHMA study protocol: a population-based multicentre stepwise study on the prevalence and characterisation of patients with asthma according to disease severity in Portugal"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct05169619","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Cristina","family":"J\u00e1come","sequence":"first","affiliation":[]},{"given":"Dinis","family":"Brito","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6921-5486","authenticated-orcid":false,"given":"Catarina","family":"Jo\u00e3o","sequence":"additional","affiliation":[]},{"given":"Filipa","family":"Lopes","sequence":"additional","affiliation":[]},{"given":"Janete","family":"Santos","sequence":"additional","affiliation":[]},{"given":"Liliana","family":"Amorim","sequence":"additional","affiliation":[]},{"given":"Maria Jo\u00e3o","family":"Barbosa","sequence":"additional","affiliation":[]},{"given":"Marisa","family":"Pardal","sequence":"additional","affiliation":[]},{"given":"Pedro","family":"Teixeira","sequence":"additional","affiliation":[]},{"given":"Filipa","family":"Bernardo","sequence":"additional","affiliation":[]},{"given":"Joao A","family":"Fonseca","sequence":"additional","affiliation":[]},{"given":"Jaime","family":"Correia-de-Sousa","sequence":"additional","affiliation":[]}],"member":"239","published-online":{"date-parts":[[2022,9,19]]},"reference":[{"key":"2022091910053902000_12.9.e064538.1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00202013"},{"key":"2022091910053902000_12.9.e064538.2","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02094-2020","article-title":"Trends in worldwide asthma prevalence","volume":"56","author":"Asher","year":"2020","journal-title":"Eur Respir J"},{"key":"2022091910053902000_12.9.e064538.3","doi-asserted-by":"crossref","DOI":"10.1186\/2045-7022-4-24","article-title":"Operational definitions of asthma in recent epidemiological studies are inconsistent","volume":"4","author":"S\u00e1-Sousa","year":"2014","journal-title":"Clin Transl Allergy"},{"key":"2022091910053902000_12.9.e064538.4","doi-asserted-by":"publisher","DOI":"10.1186\/2045-7022-2-15"},{"key":"2022091910053902000_12.9.e064538.5","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-11-347","article-title":"Asthma in an urban population in Portugal: a prevalence study","volume":"11","author":"de Sousa","year":"2011","journal-title":"BMC Public Health"},{"key":"2022091910053902000_12.9.e064538.6","unstructured":"da Sa\u00fade D-G . 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