Background
The steroid sparing benefits of asthma biologics are well known. Some patients do not fit eligibility criteria while biologics may not be necessary for others. We developed a structured, clinical nurse specialist (CNS)-led steroid weaning clinic for patients on maintenance oral steroids (mOCS) for severe asthma (SA).

Methods
Retrospective data was reviewed for 20 biologic naïve OCS-dependent SA patients who received 2-4 weekly virtual reviews by the CNS. When needed, patients attended for biomarker and clinical review. Patients received input from the respiratory physiotherapist and clinical psychologist if indicated.

Results
Mean age (SD) was 49 (16) years, 15 were women and baseline eosinophils 0.0 (IQR 0-0.15). 13 had comorbid breathing pattern disorder, 16 had GORD, 9 had anxiety and 12 were diagnosed with depression. The median duration of mOCS use prior to weaning was 44 months (IQR 5-117). Median dose of mOCS at baseline was 20mg/day (IQR 10-25). Over a median of 7 months (IQR 4.5-13), 13 patients (65%) either weaned off mOCS completely or weaned to adrenal insufficiency dose (n=4, dose ?5mg). The remaining 7 patients are continuing to wean: median dose currently 8mg/day. ACQ reduced from 3.3 (IQR 2.4-4.0) at baseline to 2.8 (IQR 2.0-3.5). The median cumulative OCS exposure per patient prior to commencing weaning was 14.4g (IQR 3.3-360).

Discussion
Structured OCS weaning supported by a CNS was successful in weaning steroids even in patients with comorbidities and who had been on mOCS for several decades. The systemic side effects of OCS start developing at 1g of lifetime exposure and clinical teams should focus on multi-disciplinary input and structured support to enable OCS weaning.