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Background Biologic therapies have transformed the management of severe asthma, offering new hope to patients with uncontrolled disease. However, the real-world consistency of clinical benefit across network treatment centres remains poorly characterised. This study aimed to evaluate the magnitude of response to biologics and assess variation in outcomes across both hub and spoke sites within a regional asthma service.Methods We conducted a retrospective cohort study of 101 patients with severe asthma who commenced biologic therapy between April 2022 and March 2023 across The Portsmouth Severe Asthma Service regional network comprising Portsmouth Hospitals University NHS Trust (PHU) and affiliated non-PHU sites. Paired data from baseline and 12 months were analysed for annual exacerbations, hospital admissions, asthma control (ACQ), asthma-related quality of life (AQLQ), and maintenance oral corticosteroid (mOCS) use. Clinically meaningful improvement was defined as: ≥50% reduction in exacerbations or admissions, ≥0.5-point reduction in ACQ, ≥0.5-point increase in AQLQ, or ≥50% reduction in mOCS dose. Statistical comparisons were made between sites using chi-square tests.Results Among evaluable patients, 91.1% achieved ≥50% exacerbation reduction, 68.7% improved ACQ, 65.8% improved AQLQ, 25.7% reduced hospital admissions, and 72.2% of those on mOCS at baseline were completely weaned off by Year 1. Comparisons between PHU and non-PHU patients revealed no significant differences across any outcome. For example, exacerbation response rates were 90.2% vs 92.0% (PHU vs non-PHU), ACQ improvement 68.3% vs 69.0%, and AQLQ improvement 65.7% vs 65.8% respectively (all p > 0.05). Additionally, site-level analyses across individual hospitals demonstrated no statistically significant variation in responder rates, despite small patient numbers at some locations.Abstract P203 Figure 1Proportion of patients achieving key clinical outcomes at PHU and non-PHU sites. Exacerbation reduction, ACQ and AQLQ improvements, and mOCS weaning were consistently high across sites, demonstrating uniform biologic efficacy throughout the networkExacerbation reduction, ACQ and AQLQ improvements, and mOCS weaning were consistently high across sites, demonstrating uniform biologic efficacy throughout the network.Conclusion Biologic therapies confer substantial clinical benefit in real-world severe asthma, with high rates of symptom control, steroid reduction, and quality of life improvement. Importantly, these outcomes were achieved consistently across the Portsmouth network of hospitals, including both specialist and district general settings. This reinforces the effectiveness and equity of biologic delivery across decentralised asthma care models, supporting their continued integration across regional and national severe asthma services.