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Introduction Overuse of oral corticosteroids (OCS) is associated with long-term morbidity for patients with asthma. Recent data has shown those with little evidence of type-2 (T2) inflammation may not respond as well to OCS treatment compared with T2 high patients. 1 Aims To measure outcomes of patients experiencing asthma exacerbations treated with a T2 biomarker guided strategy.Methods Data were collected from patients attending a tertiary severe asthma ‘rapid access’ service. Patients contacted the service when they reported an increase in symptoms, were seen urgently, and underwent a comprehensive assessment with FeNO, viral swab, sputum culture, blood sampling for WBC (including eosinophil count [BEC]), CRP, and either peak flow measurement or simple spirometry. A clinical decision was then made whether or not to treat the patient with OCS. Patients were followed-up 30 days after the visit and need for further treatment was recorded.Results In the period between June 2024 – May 2025, 77 patients were assessed with a mean (SD) age of 55.0 (19.2]), 76% (n=58) were female and 70% (n=54) were biologic naïve. Treating clinicians prescribed OCS for 40% (n=31) of patients. BEC were significantly lower in those not prescribed OCS (0.13 vs 0.37 x10 9/L, p<0.01), as were FeNO levels (35 vs 60 ppb, p=0.027). Those who received OCS had a significantly lower PEFR (percentage of best: 76.3 vs 87.8, p<0.01) and a lower CRP (5.4 vs 19.1, p=0.034). There was no difference in the proportion of patients who required further treatment at follow-up between those who received OCS and those who did not (n [%] 2 [6.5] vs 4 [8.7] respectively, p=0.87).Abstract P194 Table 1Conclusions Over 50% of patients presenting with increasing symptoms were managed without OCS and did not require a course of OCS or hospitalisation at 30-day follow-up. Those managed without OCS had significantly lower T2 biomarkers. A randomised clinical trial of T2 guided OCS is required to understand whether this strategy is non-inferior to ‘blanket’ OCS prescribing.Reference Celis-Preciado C, et al. European Respiratory Journal 2025 May.