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Introduction Biologic therapies have revolutionised asthma management by reducing acute exacerbations and oral corticosteroids (OCS) exposure. Asthma exacerbations are unpredictable, heterogenous events. Rapid biomarker assessment including type 2 inflammation (Th2) ensures targeted use of OCS and optimisation of treatable traits. 1 We describe a pragmatic, biomarker-led rapid access service at a regional complex airways service designed to enable timely access to objective specialist assessment.Methods The Complex Airways service at North Bristol NHS Trust (UK) implemented a rapid access, face-to-face, nurse-led clinic for assessment of acute asthma exacerbations. Patients were assessed for clinical signs including wheeze, blood eosinophils, fraction exhaled nitrous oxide (FeNO), peak expiratory flow rate (PEFR) and spirometry when available. We reviewed outcome data for patients attending this clinic.Results Between November 2023-March 2025, 97 patients were assessed. All patients presented with acute symptoms of exacerbation and had already initiated rescue high dose OCS or were due to start. 66% (n=64) were female and 78% (n=76) on an asthma biologic. Figure 1 describes biomarker results and subsequent OCS use following assessment. 69% (n=67) of patients were managed for one, or a combination of infection, inducible laryngeal obstruction (ILO) and breathing pattern disorder (BPD) and avoided high dose OCS. Only 2 patients, who were given antibiotics and no OCS, subsequently required rescue prednisolone. 31% (n=20) had already started high dose OCS and 9 patients were not adequately endotyped for assessment. 3 patients on no OCS and no evidence of Th2 inflammation were given high dose OCS (likely secondary to wheeze and drop in PEFR/FEV1). Other contributors to asthma symptoms including BPD and rhinosinusitis which were evident in 26% in the total population.Abstract M28 Figure 1Flowchart of exacerbation management by oral corticosteroid use prior to assessmentConclusions Biomarker led rapid access clinics for asthma exacerbations reduces OCS use and identifies important treatable traits including infection, ILO and BPD. We have identified the need to standardise the biomarkers required for comprehensive assessment and recognise the importance of improving access to early intervention and education to prevent unnecessary use of rescue packs prior to assessment.Reference Donohue JF, Jain N. Exhaled nitric oxide to predict corticosteroid responsiveness and reduce asthma exacerbation rates. Respir Med. 2013;107(7):943–52.