Background; ICS is the mainstay of asthma management, but adherence is often poor. Biologic therapy is used in children with severe asthma, who remain symptomatic despite addressing basic asthma management to good asthma control. Changes in ICS adherence following initiation of biologics is unknown. We hypothesized that adherence to ICS is reduced in children well established on asthma biologic therapies.

Method: A retrospective analysis of data collected during annual reviews of children on biologics at a regional paediatric severe asthma centre between 2018- 2023. This included:number of oral corticosteroid (OCS) courses, spirometry, Asthma Control Tests (ACT/pACT), ICS prescription uptake, 12 months before starting a biologic & most recent assessment. 

Results: 24 children with median age of 15 years(yr.) (range 7-16 yr.) at the start of  treatment were identified.  As a group, the number of OCS courses reduced from median of 6 (range 2-12) to 2 (range 0-6), p=0.001. The FEV1 improving significantly from median of 69% (range 50%- 105%) to 90% (43%-112%), p= 0.001. ACT scores improved from a median of 16  (range 4-22) to 22 (11-25), p= <0.0001.

8 patients (33.3%) had ICS uptake of ?50% but all had improved asthma control.The ICS pick up improved from 70% (range 20-88%) to 78% (range 9- 118%), p= 0.4. 

Outcome: Patients on biologic therapy have improved ICS uptake, asthma control, FEV1& reduced OCS courses at12 months.

Further studies to explore the disease modifying effects of biologics in children & the impact of regular contact with healthcare professionals, both at biologic administristation & annual review should be explored.