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Introduction Improving asthma control and reducing the use of short-acting beta agonist (SABA) inhalers is associated with a reduction in greenhouse gas (GHG) emissions. We aimed to assess the impact of biologic treatment for people with severe asthma (pwSA) on GHG emissions from healthcare utilisation and asthma medication usage.Methods In this multi-centre study, data were retrospectively collected for pwSA. Data on healthcare utilisation, medication usage, and distance travelled were collected for the following 3 periods: 24–12 months prior to, 12 months prior to, and 12 months following initiation of any biologic therapy for severe asthma.Results 80 patients (55% Female, n=44) with a mean age of 59.8 (SD =13.3) were included in this study. There was a significant reduction in mean total CO2 emissions [kgCO2] 12 months after initiation of biologic therapy when compared to the previous 12 months (815.4 vs 491.15, p=0.007), however, there was no significant difference in emissions when comparing the period 24–12 months before with either 12 months before or 12 months after initiation. There were also significant reductions in mean total medication CO2 emissions [kgCO2] (498.7 vs 330.9, p<0.001) and median healthcare contact emissions (11.5 vs 1.0, p<0,001) 12 months after initiation of biologic therapy when compared 12 months pre-biologic. There was a numerical difference in carbons emissions [kgCO2] attributable to SABA inhalers between the periods 12 months prior to and following biologic initiation, however this was non-significant (284 vs 233, p=0.129).Abstract S159 Figure 1Bar charts/Box and whisker plots demonstrating: A) changes in total CO2 emissions B) Healthcare-related emissions C) Emissions due to SABA inhalers D) Emissions due to non-SABA medications in the periods 24 months prior, 12 months prior, and 12 months following biologic initiationConclusions Biologic therapy for pwSA significantly reduces total, non-SABA medication-related, and healthcare-associated carbon emissions in the 12 months following initiation, compared to the 12 months prior to starting treatment. However, there was no significant difference between the periods 24–12 months before initiation and 12 months after initiation. This suggests that poor control in the 12 months prior to initiation is associated with greater emissions and improved control with biologics reduces emissions. Previous data have shown a similar reduction in healthcare contact-related CO2 emissions but not overall emissions. 1 Our data suggest biologic treatment reduce carbon emissions from all aspects of asthma care.Reference Busby J, et al. ERJOR 2025.