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Background and Importance People with asthma always have some underlying inflammation in the airway that can usually be treated with a combination of quick-relief and long-term controller medicines. But some people may not respond well to inhaled corticosteroids or other long-term controller medicines, a sign that they may be suffering from severe asthma.In that case we may use Tezepelumab a monoclonal antibody directed against thymic stromal lymphopoietin (TSLP), preventing its interaction with the TSLP heterodimeric receptor.Aim and Objectives To evaluate the clinical and demographic characteristics of patients with uncontrolled severe asthma who were candidates for tezepelumab treatment, and to analyse their response in a real-world clinical setting.Material and Methods Observational, retrospective and single-centre study included patients with severe asthma treated with tezepelumab between November 2023 and July 2024.Demographic and clinical variables were collected from the electronic health record (HCIS), and the severe asthma unit database. We used the Unified Prescription Module (MUP) for dispensing records.Results Thirty-six patients were included, 77% of whom were women. The median age at tezepelumab use initation was 62 years (range: 18-83).Regarding adherence to maintenance inhaled therapy, 63% of patients demonstrated good adherence defined by an adherence rate over 80%.The reasons for starting tezepelumab treatment were: Failure of a previous biologic in 57% of cases, overlapping phenotypes or pathogenic pathways in 28%, non-T2 asthma in 6%, and adverse events to previous biologics in 9%.Among patients with a prior biological treatment, 47% had received only one, 32% two, and 21% three biological drugs.Before starting treatment with tezepelumab, 89% of patients received oral corticosteroids (OCS) as maintenance therapy. However, only 49% of them continued OCS after treatment initiation.Conclusion and Relevance Tezepelumab was mainly selected in cases of prior biological treatment failure.Patients with uncontrolled severe asthma who was treated with tezepelumab showed improvement in disease control, as evidenced by a reduction in OCS use.These findings suggest that tezepelumab represents a promising therapeutic option for uncontrolled severe asthma, particularly in patients with a history of inadequate response to other biologics.Continuous follow-up is warranted to assess its long-term impact on disease control.Conflict of Interest No conflict of interest