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Introduction Inhaled and systemic corticosteroids are fundamental in asthma management, particularly in severe cases. Prolonged use can lead to adrenal suppression (AS), a potentially life-threatening condition that often remains undetected. Existing guidelines primarily focus on high-dose steroid exposure, potentially underestimating risk in patients on medium-dose inhaled corticosteroids (ICS).Objectives This evaluation aimed to assess the prevalence of adrenal suppression in patients referred to a severe asthma clinic and identify associated risk factors.Methods A retrospective review was performed using electronic health records from consecutive patients referred to the Severe Asthma Clinic from the Asthma and Allergy Clinic in the last 2 years at Wythenshawe Hospital. Data collected included ICS and oral corticosteroid (OCS) doses, additional steroid routes, morning serum cortisol levels, synacthen test outcomes, and relevant risk modifiers. ICS doses were standardised to beclomethasone dipropionate (BDP) equivalents, and adrenal function was assessed using NICE and local thresholds.Results Of the 38 patients reviewed, 28 patients met inclusion criteria. 78.6% of the cohort was female (n=22) with a mean age of 47.3 years (range 27–69). 86% had abnormal morning cortisol results (see figure 1), yet only 7 underwent synacthen testing, of which 2 failed (29%). Most patients were on high-dose ICS (68%), and 57% had taken at least one OCS course within the last year. Notably, even among those on medium-dose ICS with no OCS use, abnormal cortisol results were common. Additional steroid exposure and enzyme inhibitors were common, indicating additive risk.Abstract P299 Figure 1Distribution of morning cortisol results among the study cohortConclusion Cortisol suppression is prevalent in this cohort and could be under-recognised in the severe asthma population, including those on medium-dose ICS. The findings suggest that current screening thresholds may be insufficient and highlight the importance of assessing cumulative steroid burden, including non-oral routes and interacting medications. Greater clinician awareness, routine biochemical screening in pre-selected high-risk individuals, and provision of steroid emergency cards are essential to reduce preventable morbidity. Future prospective studies are needed to assess the risk of adrenal suppression in patients on long-term medium and high dose ICS and inform national guidelines.