Prevalence of psycho-social factors in Children with Problematic Severe asthma (PSA) referred to a tertiary centre for consideration of a biologic

<bold>Background:</bold> Children and young people (CYP) with problematic severe asthma (PSA) may have potentially modifiable reasons for poor control. A multi-disciplinary team (MDT) assessment to identify and address these may avoid the need for expensive biologics. Psychosocial issues are an important contributor to poor asthma control. <bold>Objective:</bold> To determine the prevalence and nature of psycho-social concerns in CYP with PSA in a tertiary referral centre. <bold>Methods:</bold> Retrospective review of CYP prospectively assessed by an MDT asthma team between 2013-2023. Psycho-social issues where categorised as: poor adherence measured by GP prescription uptake and electronic monitoring devices (EDM): smoke exposure (urinary cotinine); psychological - Paediatric Index of Emotional Distress (PI-ED); and safeguarding concerns. <bold>Results:</bold> 427 CYP median (range) age 11.7 (5.1 – 17.6) years, 57% male, were assessed. Median EMD adherence was 70% (range 1 – 100%) and prescription uptake 66% (8 – 100%). 150/233 (60%) had adherence <80% when monitored. Median PI-ED score was 13 (0 – 48); 40/214 (19%) had a score ≥20, indicating significant emotional distress. Median PAQLQ score was 4.76 (range 1.38 – 7) indicating an impact on quality of life in most children. Safeguarding issues were identified in 73 (17%) and 39 referrals to Children’s Social Care were made. Only 60/427 (14%) progressed to a biological therapy. <bold>Conclusion:</bold> Psycho-social issues are common in children referred with PSA. An MDT approach is essential for the assessment of these complex cases and implementation of appropriate management can avoid unnecessary escalation of treatment.