Real-world characterisation of severe asthma in Greece: results from the Greek Severe Asthma Registry

Background Severe asthma (SA) imposes a disproportionate burden on patients and healthcare systems worldwide, yet region-specific data from Southern Europe remain scarce. The Greek Severe Asthma Registry (GSAR), an initiative of the Hellenic Thoracic Society, provides the first nationwide characterisation of severe asthma in Greece. Methods We analysed data cross-sectionally from 619 adult patients (median age: 56 years; 61.1% female) with severe asthma, recruited across 13 specialised hospital centres and 11 private respiratory practices between March 2018 and November 2021. Patients were stratified by age of asthma onset, biologic therapy use and maintenance oral corticosteroid (mOCS) dependence. Clinical, inflammatory and treatment characteristics were assessed, alongside exacerbation predictors. Results The study population exhibited substantial disease burden, with 434 patients (70.1%) experiencing ≥1 exacerbation and 149 (24.1%) requiring hospitalisation in the prior year. Late-onset asthma (60.7%) was associated with a faster progression to severe disease, higher exacerbation risk (79.8% versus 69.5%, p=0.004), and more frequent cardiometabolic comorbidities versus early-onset asthma. Despite better asthma control (Asthma Control Test ≥20: 61.8% versus 50.5%, p=0.012), biologically treated patients (57%) had more severe disease, including lower forced expiratory volume in 1 s (FEV 1 ) % predicted (73% versus 81%, p