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Introduction/Aim GINA guidelines 2024 currently recommend step-up to either ICS/LABA/LAMA or high dose ICS/LABA for patients whose asthma remains uncontrolled on medium dose ICS/LABA. However, there is a lack of real-world evidence on patient characteristics prior to the choice of treatment.This study will generate further understanding on the patient characteristics of both populations in a RW setting.Method Utilising UK patients’ electronic medical records extracted from the Optimum Patient Care Research Database (2.9 million patients with asthma; mean follow-up of 11.4 years), this cohort study included adults diagnosed with asthma initiating msBDP/FF/G or hsICS/LABA on/after 1st January 2017 following ≥1 year of msICS/LABA use. Patients’ baseline characteristics were described and stratified by msBDP/FF/G or hsICS/LABA usage.Results 2,566 patients prescribed msBDP/FF/G and 15,113 patients prescribed hsICS/LABA were included, with similar sex distribution (59,0% vs 63,5% male), ethnicity distribution (white 88.9% vs 84.5, black 2.8% vs 4.9%, asian 0.2% vs 1.4%) and prevalence of allergy diagnosis (52.5% vs 53.6%). Patients prescribed msBDP/FF/G were older than those prescribed hsICS/LABA (mean±standard deviation: 65.7±14.0 vs 53.2±17.3 years), were more active smokers (30.6% vs 17.2%), and had higher prevalence of concomitant COPD diagnosis (44.0% vs 5.4%), and cardiovascular risk factors or diseases - hypertension (48.6% vs 31.6%), diabetes (24.5% vs 13.8%), ischaemic heart disease (24.9% vs 11.3%), heart failure (6.9% vs 2.7%), and chronic kidney disease (14.2% vs 7.3%) -, but less allergic rhinitis (21.7% vs 28.7%). In the year prior, patients prescribed msBDP/FF/G had lower percent predicted PEFR (median 63.1% vs 74.3%) and percent predicted FEV1 (median 65.0% vs 78.7%), two or more exacerbations (32.6% vs 19.0%), three or more SABA prescription (69.7% vs 58.4%) and also had higher cumulative oral corticosteroid doses (684.4±926.8 mg vs 533.4±865.8 mg).Conclusion msBDP/FF/G was preferentially prescribed over hsICS/LABA to patients with asthma-COPD overlap, severe disease, and who were older and active smokers. Exacerbations, SABA, steroid burden and cardiovascular co-morbidities were also important drivers. Confounder-matched/adjusted comparisons of efficacy between msBDP/FF/G and hsICS/LABA are warranted.