Introduction: Asthma is known to be associated with cognitive impairment, but the association with severe asthma, and the effect of biologics have not previously been described.

Aims: To investigate the proportion of patients with cognitive impairment among patients with severe asthma commenced on a biologic and the early effects on cognition.

Methods: Cognitive impairment was assessed in a population of patients with severe eosinophilic asthma, in the 3TR Asthma Biologics Cohort study, before commencing anti-IL4R treatment, and after 4 months. Objective cognitive functions were assessed with a brief performance-based test battery consisting of the Screening for Cognitive Impairment in the Psychiatry (SCIP) - Danish Version and the Trail Making Test-Part B. In addition, subjective cognitive functions were assessed with the Cognitive Failures Questionnaire.

Results: At baseline; 64% of patients had significant cognitive impairment compared to their expected performance with verbal learning and memory and executive functioning being most severely affected (p ? .030). At re-assessment after 4 months of treatment with Dupixent, patients generally reported less subjective symptoms of cognitive impairment (p = .041), and had a showed a significant improvement in executive functioning measured with TMT-B (p = .001). However, no improvements in verbal and memory function skills were observed at this point.

Conclusion: Cognitive impairment is common among patients with severe asthma commenced on anti-ILR4 treatment: early effects were observed on subjective perception of cognition and executive functions, but longer-term treatment may be needed to show effect.