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Background and Importance Tezepelumab, a monoclonal antibody against thymic stromal lymphopoietin (TSLP), is indicated as maintenance therapy in addition to high-dose inhaled corticosteroids (ICS) in severe asthma. Adherence to maintenance therapy is a determining factor in disease control, and suboptimal adherence has been observed in up to 50% of patients.Aim and Objectives To evaluate clinical outcomes of tezepelumab in severe asthma patients according to adherence to ICS maintenance therapy.Material and Methods A retrospective, observational study was conducted at a tertiary hospital (November 2023–July 2025). Patients with uncontrolled severe asthma receiving at least 3 months of tezepelumab were included. Baseline and last available data were extracted from medical records: sex, age, smoking status, prior biologics, oral corticosteroid use, emergency visits, ICS dispensation, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio Adherence to ICS was assessed using pharmacy dispensing records.The data were processed using LibreOffice Calc and SPSS Statistics version 25. Quantitative variables were expressed as mean and standard deviation (SD), and qualitative variables as frequencies (%). A statistical significance level of p<0.05 was established.Results Forty five patients were included. ICS adherence: 71% adherent vs 39% non-adherent. Women: 71% vs 65%; mean age 63.2±12.8 vs 56.3±9.9 years; smokers: 18% vs 42%; prior biologics: 36% vs 50%; oral corticosteroids: 39% vs 61%; emergency visits: 17% vs 39%.Spirometry: FEV1 baseline 78.1±25 vs 72.0±24.8%; FEV1 final 84.0±24.6 vs 74.2±26.7%; FVC baseline 90.4±21.7 vs 88.0±18.6%; FVC final 95.6±22.9 vs 89.2±16.8%; FEV1/FVC baseline 85.8±15.1 vs 82.0±16.5%; FEV1/FVC final 88.8±16.9 vs 83.3±17.8%. No statistically significant differences (p>0.05).Conclusion and Relevance Patients treated with tezepelumab showed improvements in lung function in both groups, although these were not statistically significant. Patients who did not adhere to ICS treatment showed greater dependence on oral corticosteroids, more emergency room visits, and attenuated functional gains, confirming the negative clinical impact of non-adherence from other studies. However, the small sample size limits the generalisability of these findings, and larger real-world studies are needed.Conflict of Interest No conflict of interest