Introduction : The RAMSES cohort (NCT04077528) is an ongoing study aiming to analyze the use of step 5 treatment strategies in adults with severe asthma in France.

Aims and objectives:  The objective of the study was to determine whether severe asthma characteristics and care trajectories differed between secondary care centres (SCC) and tertiary referral centres (TRC) participating in the RAMSES cohort.

Methods : Patients were prospectively recruited and enrolled for a 5-yrs follow up in 43 centres, all experienced in the management of severe asthma.Patients? characteristics were analysed at inclusion and compared between SCC and TRC.

Results : Among the 1963 patients (62% women, 53±15 yr old, 66% with Asthma control test <20), 16% received at inclusion oral corticosteroids and 65% biologics, alone or in combination. TRC (n=19) included 1407 patients (72%) and SCC (n=24) 556 patients (28%). Compared with SCC, the TRC group had by more frequent comorbidities, lower eosinophil count (260/mm3 vs 330/mm3, p=0.009). OCS and biologics use did not differ between groups but patients in the TRC group benefited more frequently from an educational program (27% vs 18%, p=0.003), and received more frequently ?2 lines of biologics (32% vs 22%, p=0.0029).  In-depth investigations were more frequently performed in the TRC group (allergy tests: 76% vs 62%, FeNO : 63% vs 23%, induced sputum: 40% vs 19%, all p<0.0001).  

Conclusions: Phenotypes and care trajectories differed in the RAMSES cohort between SCC and TRC, probably related to different levels of asthma severity and differences in medical resources and practices among centres. This highlights the need for standardization of severe asthma care in France.