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Background Respiratory Viral Infections are common cause of asthma exacerbations. However, whether pre-existing asthma worsens, mitigates or merely changes the clinical expression of respiratory viral infections (RVIs) in hospitalised adults remains uncertain. We analysed prospectively collected data from the multicentre UK UNIVERSAL study – a prospective observational cohort spanning 12 hospitals – to compare symptom burden, inflammatory profile and outcomes in adults with and without asthma.Methods Consecutive adults (≥18 years) prospectively enrolled on admission between Aug 2022 and May 2025 with PCR-confirmed RVI were stratified by clinician-diagnosed asthma. Symptom burden at admission was assessed with FLU-PRO Plus (0–100, six domains). Physiological severity was recorded daily using the WHO Ordinal Scale for Clinical Improvement (OSCI, 0–8). Primary outcomes were (i) occurrence of OSCI ≥ 5 and (ii) number of days with OSCI ≥ 5. Secondary outcomes were ICU/HDU admission and 60-day all-cause mortality. Categorical variables were compared with Fisher’s exact test, continuous variables with the Mann-Whitney U test.Results Of 836 patients, 306 (36.6%) had asthma. Baseline characteristics are summarised in table 1.Asthmatics were younger (median 57 vs 67 y), more frequently female (68% vs 44%), and more often infected with rhinovirus/enterovirus (25% vs 17%; all p<0.05). Systemic inflammation was lower in asthmatics (CRP > 10 mg L− 1 71% vs 86% p<0.001 ; lymphopenia 38% vs 50% p<0.004), while eosinophils ≥0.20×109/L was more frequent (25.4% vs 18.8%, p=0.025).Asthma patients reported significantly greater symptom burden, with higher median FLU PRO Plus scores in the chest/respiratory (60.9 vs 52.2, p<0.001), nose (36.0 vs 29.2, p<0.001), and systemic domains (39.5 vs 33.8, p=0.002).Despite higher symptom burden, asthma patients were less likely to reach OSCI ≥5 (61.4% vs 72.0%, p=0.002), experienced fewer calendar days with OSCI ≥5 (≥5 days: 12.4% vs 16.3%, p=0.015), and had lower 60-day mortality (1.1% vs 5.1%, p=0.006). ICU/HDU admission rates were similar (2.8% vs 3.0%, p=0.922).Abstract P179 Table 1Patient characteristics by asthma statusConclusion Asthma was associated with a distinct clinical profile characterised by increased upper and lower respiratory symptom burden but lower systemic inflammation and reduced short-term mortality.