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Background The ACP secondary care airways clinic supports primary and emergency care with the diagnosis and optimisation of airways disease patients in a large inner city teaching hospital. Eosinophilic airways disease (EAD) is highlighted within the national guidance to seek early optimisation to reduce exacerbation, improve quality of life and prevent avoidable long-term airways damage.157 new patients have attended the clinic with their outcomes reviewed following new diagnosis or optimisation to understand the impact of poorly controlled EAD management on secondary care respiratory referrals.Objectives 1. Identify the number of EAD being referred for optimisation/diagnosis2. Determine use of best practice guidelines for EAD in our local area.Methods Case notes of new patient’s referred to the clinic were reviewed over a 12-month period. Criteria for referral included suspected/poorly controlled airways disease from either Primary care or Emergency/Ambulatory care. presenting complaints, initial eosinophils >0.30 x10(9) and primary diagnoses were reviewed. Escalation of treatment was as per national guidance.Results 157 patient referrals were reviewed: median age 60 years (IQR 21–86); female 54%; BAME 25%. Referral source: 6% from urgent care; 7 GP referrals; 87% Airways Team and 6% from other Respiratory Consultants. New diagnosis 103 (66%) of which 62% were eosinophilic with 32% ICS naive and initiated as part of their management. 15% were encouraged to improve compliance with their existing ICS.21% (N=33) received disease optimisation of which 73% were eosinophilic (n=24). 52% (n=17) had their ICS escalated. 7% had a change of ICS device.Other non-airways diagnoses were made in 4%. 5% self-resolved by the time of review.Conclusion The recognition of EAD as a need for referral is evident but the management of EAD within primary and emergency care is lacking despite the production of local, national and international guidelines. A ‘one stop’ clinic to serve and optimise patients has proved integral to manage this patient cohort and streamlining secondary care respiratory referrals. Ongoing work within primary/emergency care is needed to reduce poor outcomes by applying best practice particularly to our EAD is cohort who have increased risk of exacerbation, healthcare utilisation and poor outcomes.