Document resource
Background Biologic have revolutionised the management of severe asthma, reducing exacerbations, hospital admissions, and oral corticosteroid use, while improving quality of life. In England, biologics are initiated at nationally commissioned severe asthma centres for patients with uncontrolled severe asthma. We aimed to assess patterns of biologic initiation and identify potential inequities in access.Methods Biologic initiation data from Blueteq (January 2016-February 2025) were linked to patient-level datasets, including Hospital Episode Statistics (HES). Initiation rates were compared to the estimated eligible population (1.5% of the QOF adult asthma population) across Integrated Care Boards (ICBs). Demographics, including ethnicity and socioeconomic status, were evaluated to explore inequities in access.Results Biologic uptake increased from 738 patients in 2016 to over 21,000 by early 2025. Since 2021, the number of patients on biologics has grown by 23–27% annually. Annual initiations more than doubled from 2,008 (2021–2022) to 4,044 (2024–2025). However, an estimated 37,000 eligible patients remain untreated. Initiation rates varied markedly across ICBs- from 20% to 60% of eligible patients, with higher uptake in regions served by specialist centres ( figure 1). Proximity to severe asthma centres correlated with higher initiation rates.No significant disparities were found in initiation rates by gender, age, ethnicity, or deprivation index. Biologic initiation was associated with a 50% reduction in asthma-related non-elective hospital admissions and bed-days in the year following initiation compared to the previous year- in 2023, among 3,634 patients, hospital admissions decreased from 1,650 to 790 and bed-days from 6,500 to 3,500.Abstract P76 Figure 1Conclusion While biologic use has steadily increased, a large unmet need persists. Based on our conservative estimate that 1.5% of adult asthma patients require biologic treatment, approximately 66% (~37,000 patients) of eligible individuals are not yet receiving therapy. The absence of demographic inequity is encouraging, but substantial regional variation suggests structural barriers in access. Expanding expertise and assessment capacity beyond specialist centres, alongside earlier identification of patients with uncontrolled asthma and timely referral from primary care are essential to improve equity, reach underserved populations and ensure that all eligible patients benefit from systematic assessment, multi-disciplinary team input and these transformative therapies.