Abstract Seasonal respiratory viral infections are the major cause of increased pressure on national health systems such as the UK’s national health service (NHS) during winter months. Emergency departments and hospitals are full as increasing numbers of patients require hospitalisation for lower respiratory tract infections and exacerbations of COPD, asthma, and other respiratory conditions. These winter pressures are largely predictable. Forecasting models give healthcare managers the chance to mitigate winter pressures by allocating resources more effectively. Despite this predictability and the production of NHS resilience plans, the UK is particularly susceptible to winter pressures. Communities facing social and environmental disadvantage are at increased risk of hospitalisation. Despite the focus on real-life research and guideline dissemination and implementation over the last 20–30 years, care of patients with respiratory conditions in the UK remains sub-optimal. To tackle winter pressures, a different approach is needed. The UK Centre for Applied Respiratory Research Innovation and Impact (CARRii) is a new UK-wide network which aims to drive policy change and use innovative ways of implementing research to achieve maximum impact on patient care. Its missions are to reduce NHS winter pressures and respiratory health inequalities, and its focus is on three areas: prevention; self-management and connected care; and optimisation of clinical care. CARRii unites leading experts across respiratory research, clinical medicine, data science, public health, industry innovation, and patient advocacy. CARRii’s first Annual Scientific Meeting was held recently. Implementation of research is more likely to succeed if it is based on real-world data, there is multi-agency involvement in its design and implementation, it is patient-focussed, and policy makers are convinced of its benefits. By positioning implementation and impact as a central scientific goal, CARRii aims to show how healthcare systems can deliver respiratory solutions at scale. This requires investment and cross-sector collaboration. If successful, this approach will reduce winter pressures, improve health equity and strengthen system resilience.

BACKGROUND:Traffic-related air pollution is a risk factor for lung disease and early mortality. Clean air zones are public health policy interventions used to reduce traffic-related air pollution in urban areas, but evidence of their health benefits is limited. We describe a natural experiment study evaluating the impact of the Ultra Low Emission Zone (ULEZ) in London, UK. The primary aim was to assess the impact of the ULEZ on children's lung function growth trajectories, by comparing forced expiratory volume in 1 s (FEV1) measurements over 5 years between children in London and Luton, UK. METHODS:The Children's Health in London and Luton (CHILL) study is a prospective, two-arm, parallel cohort study. We recruited children aged 6-9 years from primary schools in central London (the original area of the ULEZ implementation) and Luton (a comparator site with no clean air zone). Children were excluded if they had symptoms of lung disease (excluding asthma) or learning or physical disabilities preventing them from giving informed assent. Lung function was measured by spirometry at annual school visits at baseline (before ULEZ implementation) and over the following 4 years. Annual residential exposures to nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters of less than 10 μm (PM10) and less than 2·5 μm (PM2·5) were estimated at each child's home address at 20 m2 resolution using a validated dispersion modelling system. The primary outcome was the annual rate of lung function growth, measured as post-bronchodilator FEV1 over the 5-year study period. We assessed growth trajectories against individualised residential exposure to NO2, PM10, and PM2·5. We used mixed-effects linear regression to compare lung function growth between London and Luton and to examine associations between air pollution exposures and lung growth. FINDINGS:Of 122 schools approached, 84 (69%) agreed to participate (44 schools in London; 40 schools in Luton). Of 9419 children invited, we recruited 3414 children (1664 in London and 1750 in Luton) between June 5, 2018, and April 4, 2019, before ULEZ implementation. 3209 (94·0%) of 3414 children were included in the FEV1 analysis (1557 children in London, 1652 children in Luton). Children were similar across the two sites in terms of age, height, and weight, with a higher proportion of girls in London (867 [56%] of 1557) than in Luton (809 [49%] of 1652). Baseline adjusted FEV1 was lower in London than Luton (difference -38 mL, 95% CI -58 to -18; p=0·0002). At baseline, children's modelled annual exposures to NO2, the pollutant most reflective of exhaust emissions, were 18·95 μg/m3 (95% CI 18·51 to 19·38; p<0·0001) higher in London than in Luton. Over the follow-up period, children's FEV1 growth increased by 10 mL/year (95% CI 5 to 15; p=0·0002) more in London than in Luton (233 mL/year vs 223 mL/year), with modelled residential exposures to NO2 decreasing faster in London than in Luton (decreases of -3·77 μg/m3 per year in London vs -1·77 μg/m3 per year in Luton; p<0·0001). After 4 years, mean FEV1 reached parity across sites: 2283 mL (2207 to 2354) in London; 2282 mL (2185 to 2376) in Luton. The proportion of children with clinically impaired lung function fell from 184 (14%) of 1280 children to 51 (9%) of 585 children in London, and from 126 (9%) of 1339 children to 41 (7%) of 606 children in Luton. INTERPRETATION:Introduction of the London ULEZ was associated with improved lung function growth trajectories in children in London compared with children in Luton, suggesting that previous deficits in lung development were restored. This evidence supports wider implementation of clean air zones as a public health intervention. FUNDING:National Institute for Health and Care Research and Natural Environment Research Council UK Research and Innovation.

Abstract Background The Ultra-Low Emission Zone (ULEZ), introduced in Central London in April 2019, aims to enhance air quality and improve public health. The Children's Health in London and Luton (CHILL) study evaluates the impact of the ULEZ on children's health. This analysis focuses on the one-year impacts on the shift towards active travel to school. Methods CHILL is a prospective parallel cohort study of ethnically diverse children, aged 6–9 years attending 84 primary schools within or with catchment areas encompassing London’s ULEZ (intervention) and Luton (non-intervention area). Baseline (2018/19) and one-year follow-up (2019/20) data were collected at school visits from 1992 (58%) children who reported their mode of travel to school ‘today’ (day of assessment). Multilevel logistic regressions were performed to analyse associations between the introduction of the ULEZ and the likelihood of switching from inactive to active travel modes, and vice-versa. Interactions between intervention group status and pre-specified effect modifiers were also explored. Results Among children who took inactive modes at baseline, 42% of children in London and 20% of children in Luton switched to active modes. For children taking active modes at baseline, 5% of children in London and 21% of children in Luton switched to inactive modes. Relative to the children in Luton, children in London were more likely to have switched from inactive to active modes (OR 3.64, 95% CI 1.21–10.92). Children in the intervention group were also less likely to switch from active to inactive modes (OR 0.11, 0.05–0.24). Moderator analyses showed that children living further from school were more likely to switch from inactive to active modes (OR 6.06,1.87–19.68) compared to those living closer (OR 1.43, 0.27–7.54). Conclusions Implementation of clean air zones can increase uptake of active travel to school and was particularly associated with more sustainable and active travel in children living further from school.

OBJECTIVE:Oral corticosteroids (OCS) are used to treat uncontrolled asthma, either as short rescue courses of treatment for severe disease exacerbations, or as long-term maintenance therapy in addition to other controller medications. Although the adverse events (AEs) associated with OCS are well understood by healthcare professionals (HCPs), the patient's perspective may be underappreciated. This review discusses the patient perspective on OCS use. DATA SOURCES:A PubMed literature review was performed. STUDY SELECTION:Articles were selected to include those primarily containing data on patient perspectives on OCS use in asthma or other airway diseases, including qualitative and quantitative studies. Articles including only clinical data and those primarily focused on another indication were excluded. Additional articles meeting the criteria were permitted based on author knowledge and the bibliographies of systematic reviews on other topics. RESULTS:A total of 6066 articles were identified from the PubMed search; 111 were assessed more closely for eligibility. Fourteen articles were eventually selected by the reviewers for inclusion and confirmed by all authors. Several key themes were identified: (1) Key AEs were prominently reported by patients (including weight gain, skin thinning, known osteoporosis/osteopenia, and sleep/mood disturbances); (2) Impact of OCS on day-to-day lives; (3) Patient perceptions of OCS; (4) Effect of perceptions on treatment adherence. CONCLUSION:HCPs should consider the impact that OCS have on their patients' wellbeing, including short courses. It is essential for HCPs to discuss the short and long-term risks of OCS with patients prior to initiation of treatment and consider alternatives for patients on long-term OCS.

The COVID-19 pandemic catalysed the development of digital health interventions across the globe, including low- and middle-income countries (LMICs) such as Malaysia. However, moving from pockets of innovation to sustainable implementation at scale remains a major challenge. This viewpoint presents insights from a digital health training programme using a multi-stakeholder engagement series convened by the National Institute for Health and Care Research Global Health Research Unit on Respiratory Health (RESPIRE) during the pandemic. Through co-designed workshops involving policymakers, healthcare providers, small and medium-sized enterprises, and academic researchers, participants examined systemic barriers to scaling digital health innovations in Malaysia, including issues with infrastructure, regulation, and workforce readiness. We used a home-based pulmonary rehabilitation initiative as a case study to explore these dynamics in practice. Broader lessons include the importance of ecosystem-building, capacity development, regulatory clarity, and inclusive design. Our findings offer transferable insights for strengthening digital health systems in LMICs.

Background There were substantial reductions in asthma exacerbations during the COVID-19 pandemic for reasons that remain poorly understood. We investigated changes in modifiable risk factors which might help explain the reductions in asthma exacerbations. Methods Multilevel generalised linear mixed models were fitted to examine changes in modifiable risk factors for asthma exacerbations during 2020 - 2022, compared to pre-pandemic year (2019), using observational, routine data from general practices in the Oxford -Royal College of General Practitioners Research and Surveillance Centre. Asthma exacerbations were defined as any of GP recorded: asthma exacerbations, prescriptions of prednisolone, accident and emergency department attendance or hospitalisation for asthma. Modi fi able risk factors of interest were ownership of asthma self-management plan, asthma annual review, inhaled-corticosteroid (ICS) prescriptions, influenza vaccinations and respiratory-tract-infections (RTI). Findings Compared with 2019 (n = 550,995), in 2020 (n = 565,956) and 2022 (n = 562,167) (p < 0.05): asthma exacerbations declined from 67.1% to 51.9% and 61.1%, the proportion of people who had: asthma exacerbations reduced from 20.4% to 15.1% and 18.5%, asthma self-management plans increased from 28.6% to 37.7% and 55.9%; ICS prescriptions increased from 69.9% to 72.0% and 71.1%; influenza vaccinations increased from 14.2% to 25.4% and 55.3%; current smoking declined from 15.0% to 14.5% and 14.7%; lower-RTI declined from 10.5% to 5.3% and 8.1%; upper-RTI reduced from 10.7% to 5.8% and 7.6%. There was cluster effect of GP practices on asthma exacerbations (p = 0.001). People with asthma were more likely (p < 0.05) to have exacerbations if they had LRTI (seven times(x)), had URTI and ILI (both twice), were current smokers (1.4x), PPV vaccinated (1.3x), seasonal fl u vaccinated (1.01x), took ICS (1.3x), had asthma reviews (1.09x). People with asthma were less likely to have exacerbations if they had self-management plan (7%), and were partially (4%) than fully COVID-19 vaccinated. Interpretation We have identi fi ed changes in modi fi able risk factors for asthma exacerbation that need to be maintained in the post-pandemic era.

BackgroundThe last 2 decades have been a time of exponential growth and maturation for digital health, while the global burden of respiratory disease continues to grow worldwide. Leveraging digital health interventions (DHIs) to manage and mitigate respiratory disease and its adverse health effects presents itself as an obvious path forward. ObjectiveWe aimed to understand the current digital landscape and enabling environment around respiratory health to reduce costs, avoid duplication, and understand the comprehensiveness of DHIs. MethodsThis study will follow a scoping review methodology as outlined by Arksey and O’Malley, the Joanna Briggs Institute, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, PakiMedNet, and MyMedR databases will be searched along with key websites, repositories, and gray literature databases. The terms “respiratory health,” “digital health,” “South Asia,” and “Southeast Asia,” as well as related terms will be searched. The results will be screened for duplicates and then against the inclusion and exclusion criteria. For the studies included, data will be extracted, collated, and analyzed. ResultsThe scoping review was started in July 2023 and will be finalized by February 2024. Results will be presented following the World Health Organization’s classification of DHIs to categorize interventions in a standardized format and the mobile health evidence reporting and assessment checklist to report on the effectiveness of interventions. Further exposition of the evidence extracted will be presented through narrative synthesis. ConclusionsAs DHIs continue to proliferate, the need to understand the current landscape becomes more pertinent. In this scoping review, we will seek to more clearly understand what digital health tools and technologies are being used in the current landscape of digital health in South and Southeast Asia for respiratory health and to what extent they are addressing the respiratory health needs of the region. The results will inform recommendations on digital health tools for respiratory health in South and Southeast Asia will help funders and implementers of DHIs leverage existing technologies and accelerate innovations that address documented gaps in the studied countries. International Registered Report Identifier (IRRID)DERR1-10.2196/52517

Every year, there are ~100,000 hospital admissions for asthma in the UK, many of which are potentially preventable. Evidence suggests that carefully conceptualised and implemented audit and feedback (A&F) cycles have the potential to improve clinical outcomes for those with chronic conditions. We wanted to investigate the technical feasibility of developing a near-real time asthma dashboard to support A&F interventions for asthma management in primary care. We extracted cross-sectional data on asthma from 756 participating GP practices in the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) database in England comprising 7.6 million registered people. Summary indicators for a GP practice were compared to all participating RCGP RSC practices using practice-level data, for the week 6–12th-Mar-2023. A weekly, automated asthma dashboard with features that can support electronic-A&F cycles that compared key asthma indicators for a GP practice to RCGP RSC could be created ( https://tinyurl.com/3ydtrt85 ): 12-weeks-incidence 0.4% vs 0.4%, annual prevalence 6.1% vs 6.7%, inhaled relievers to preventer 1.2 vs 1.1, self-management plan given 83.4% vs 60.8%, annual reviews 36.8% vs 57.3%, prednisolone prescriptions 2.0% vs 3.2%, influenza vaccination 56.6% vs 55.5%, pneumococcal vaccination ever (aged ≥65 years) 90.2% vs 84.1% and current smokers 14.9% vs 14.8%. Across the RCGP RSC, the rate of hospitalisations was 0.024%; comparative data had to be suppressed for the study practice because of small numbers. We have successfully created an automated near real-time asthma dashboard that can be used to support A&F initiatives to improve asthma care and outcomes in primary care.

Background Air pollution harms health across the life course. Children are at particular risk of adverse effects during development, which may impact on health in later life. Interventions that improve air quality are urgently needed both to improve public health now, and prevent longer-term increased vulnerability to chronic disease. Low Emission Zones are a public health policy intervention aimed at reducing traffic-derived contributions to urban air pollution, but evidence that they deliver health benefits is lacking. We describe a natural experiment study (CHILL: Children’s Health in London and Luton) to evaluate the impacts of the introduction of London’s Ultra Low Emission Zone (ULEZ) on children’s health. Methods CHILL is a prospective two-arm parallel longitudinal cohort study recruiting children at age 6–9 years from primary schools in Central London (the focus of the first phase of the ULEZ) and Luton (a comparator site), with the primary outcome being the impact of changes in annual air pollutant exposures (nitrogen oxides [NOx], nitrogen dioxide [NO 2 ], particulate matter with a diameter of less than 2.5micrograms [PM 2.5 ], and less than 10 micrograms [PM 10 ]) across the two sites on lung function growth, measured as post-bronchodilator forced expiratory volume in one second (FEV 1 ) over five years. Secondary outcomes include physical activity, cognitive development, mental health, quality of life, health inequalities, and a range of respiratory and health economic data. Discussion CHILL’s prospective parallel cohort design will enable robust conclusions to be drawn on the effectiveness of the ULEZ at improving air quality and delivering improvements in children’s respiratory health. With increasing proportions of the world’s population now living in large urban areas exceeding World Health Organisation air pollution limit guidelines, our study findings will have important implications for the design and implementation of Low Emission and Clean Air Zones in the UK, and worldwide. ClinicalTrials.gov NCT04695093 (05/01/2021).

Background Lockdown measures, including school closures, due to the COVID-19 pandemic have caused widespread disruption to children’s lives. The aim of this study was to explore the impact of a national lockdown on children's physical activity using seasonally-matched accelerometery data. Methods Using a pre/post observational design, 179 children aged 8-11 years provided physical activity data measured using hip worn tri-axial accelerometers worn for 5 consecutive days pre-pandemic and during the Jan-Mar 2021 lockdown. Multilevel regression analyses adjusted for covariates were used to assess the impact of lockdown on time spent in sedentary and moderate-to-vigorous physical activity (MVPA). Results A 10.8-minute reduction in daily time spent in moderate-to-vigorous physical activity (standard error [SE]: 2.3min/day, P<0.001), and a 33.2-minute increase in daily sedentary activity (SE: 5.5min/day, P<0.001) were observed during lockdown. This reflected a reduction in daily MVPA for those unable to attend school (-13.1±2.3 min/day, P<0,001) during lockdown, with no significant change for those who continued to attend school (0.4±4.0min/day, P<0.925). Conclusion These findings suggest that the loss of in-person schooling was the single largest impact on physical activity in this cohort of primary school children in London, Luton and Dunstable UK.

Background The COVID-19 pandemic generated a series of profound and unprecedented challenges for health and social care systems and those frontline clinicians responsible for delivering services including nurses. One consequence has been the rapid and widespread introduction of a range of digital tools, solutions, and initiatives. In the United Kingdom, this has required clinical leadership to drive implementation and adoption of digital innovations across the system, ranging from those in senior executive board level positions to those on the frontline. Findings This commentary presents a framework highlighting the breadth of digital transformations which emerged as a consequence of the U.K. health and social care systems’ response to the COVID-19 crisis. The framework outlines the different levels of digital transformation, ranging from what we have termed “ceremonial adoption” to isolated automation, organizational integration, and full systems integration. We reflect on the nursing leadership practices that need to be in place to support these changes. Conclusion Whilst acknowledging the extraordinary results achieved by the COVID-19 driven tsunami of digital transformation, we reflect on the essential steps required to translate these nascent, isolated efforts into fully integrated, long-term solutions. We also offer recommendations for clinical digital leaders and suggest steps that will be crucial to translate the temporary and/or limited interventions into effective, permanent features of our health and social care systems, while also providing a platform on which to build future digital capabilities. We will inevitably continue to see an increase in the use of technology in everyday clinical practice, and nurses are well positioned to take a lead in its widespread adoption.

Background: Older adults are the fastest growing population in the UK, but asthma is often underdiagnosed, undertreated and poorly self-managed in this population. It is necessary to explore the experiences of older adults with asthma to identify areas of research that could improve quality of life. This study aimed to explore the perceptions of older adults in the UK living with asthma and how it impacts their lives. Methods: Telephone interviews were conducted with 15 adults with General Practitioner diagnosed asthma, aged 60 years and over, from across the UK. Interviews were audio-recorded, transcribed verbatim and thematically analysed. This study was co-produced with an Asthma UK Centre for Applied Research (AUKCAR) Patient and Public Involvement Lead and guided by the National Institute for Health Research UK standards for Public Involvement in Research to ensure meaningful public involvement. Results: Themes clustered around impact of asthma, managing asthma, interaction with healthcare and understanding of asthma. Participants experienced increased physical, psychological and social impacts of asthma management as they aged which led to feelings of isolation. Competing multimorbidities and polypharmacy complicate treatment and self-management of asthma. Ageism and a lack of empathy from health care providers were mentioned by the majority participants. Quality of care varied widely across the UK, however all participants had seen a healthcare professional for an asthma review in the previous 12 months. Conclusions: Older adults experience increased challenges in managing their asthma due to increased multimorbidities, polypharmacy and ageism from healthcare providers.

Despite the implementation of effective paediatric vaccination programmes, pertussis remains a global health problem. Disease epidemiology has changed over time, shifting towards the adolescent and adult populations. In adults, the true burden of pertussis is greatly underestimated and pertussis vaccine coverage rates are suboptimal, including individuals with chronic conditions. Here, we report the outcomes of a virtual international scientific workshop to assess the evidence on the burden of pertussis in older adults and identify potential solutions to improve uptake of pertussis vaccines. In adults, pertussis is underdiagnosed in part due to atypical or milder clinical presentation and the lack of testing and case confirmation. However, contemporary epidemiological data denoted an increase in the burden of pertussis among adolescents and adults. This might be related to a variety of reasons including the waning of immunity over time, the lack of booster vaccination, and the improved diagnostic methods that led to increased recognition of the disease in adults. Pertussis sequelae can be severe in older adults, particularly those with existing chronic medical conditions, and the vulnerability of these groups is further enhanced by low pertussis vaccine coverage. Possible measures to increase vaccine uptake include strengthening and harmonisation of immunisation guidelines, healthcare professionals taking a more active role in recommending pertussis vaccination, involvement of vaccination centres and pharmacies in the vaccination process, and improving knowledge of pertussis burden and vaccine efficacy among the general population.

The Digital Health Leadership Programme is commissioned by Health Education England and part of the wider NHS Digital Academy. The Programme is a consortium of Imperial College London's Institute of Global Health Innovation, The University of Edinburgh's Usher Institute and Harvard Medical School. In 2021, Health Data Research UK joined Imperial and Edinburgh to deliver phase 2. The aim is to develop a new generation of digital health leaders to drive transformation of the NHS through digitisation. Participants gain the skills and knowledge to create change so that patient care and organisational operations can benefit from the many improvements and innovations modern technology has to offer.

Objectives The BREATHE Health Data Research Hub for Respiratory Health was formed in October 2019 as a multi-site academic consortium with multiple industrial partners via an Industry Forum and across its wider network. BREATHE’s main mission is enhancing data services within respiratory science, funded by the UKRI Industrial Strategy Challenge Fund. Approach BREATHE leveraged expertise across its founding sites and industrial partners to create data services which could be used by multiple sectors of collaborator. Across the founding sites, BREATHE was able to mobilise datasets housed within national TREs to form real-world evidence eCohorts for rapid and efficient respiratory study (Asthma, COPD, ILD), and has worked with specialists in cohort study and genomic data to house and supply these from within our partner TRE, SAIL Databank. As well as data assets, BREATHE is able to provide clinical and data expertise to collaborators for grant submissions and on bespoke respiratory science projects. Results Including a significant period of work during the pandemic supporting COVID-19 research and also focusing on other respiratory disease science support, BREATHE is now well-placed to move towards a sustainable operating plan post-grant from March 2023. Due to the approach taken in maximising data services for multiple sectors, BREATHE is positioned to provide data linkage and sharing services (making use of its TRE, SAIL Databank), providing analytic and clinical support to respiratory research projects for customers in multiple sectors (Pharma, SMEs, Academia, NHS, Charities), and advancing synthetic data and software development, again in partnership with SAIL and our wider industry partners. Conclusion As of March 2022, BREATHE has established a portfolio of data services and projects interfacing with multiple sectors of collaborator in enhancing respiratory science projects across the UK. With population-level data assets representing Wales, Scotland, and England and the ability to work with the Northern Ireland infrastructure housed at Swansea University, BREATHE supports 4-nation respiratory science in RWE data, and provides clinical and data linkage expertise to studies such as longitudinal cohorts, pharma companies, and contract research organisations.

The COVID-19 pandemic has brought a renewed focus on appropriate management of chronic respiratory conditions with a heightened awareness of respiratory symptoms and the requirement for differential diagnosis between an asthma attack and COVID-19 infection. Despite early concerns in the pandemic, most studies suggest that well-managed asthma is not a risk factor for more severe COVID-related outcomes, and that asthma may even have a protective effect. Advice on the treatment of asthma and asthma attacks has remained unchanged. This article describes some challenges faced in primary care asthma management in adults and in teenagers, particularly their relevance during a pandemic, and provides practical advice on asthma attack recognition, classification, treatment and continuity of care. Acute attacks, characterised by increased symptoms and reduced lung function, are often referred to as exacerbations of asthma by doctors and nurses but are usually described by patients as asthma attacks. They carry a significant and underestimated morbidity and mortality burden. Many patients experiencing an asthma attack are assessed in primary care for treatment and continuing management. This may require remote assessment by telephone and home monitoring devices, where available, during a pandemic. Differentiation between an asthma attack and a COVID-19 infection requires a structured clinical assessment, taking account of previous medical and family history. Early separation into mild, moderate, severe or life-threatening attacks is helpful for continuing good management. Most attacks can be managed in primary care but when severe or unresponsive to initial treatment, the patient should be appropriately managed until transfer to an acute care facility can be arranged. Good quality care is important to prevent further attacks and must include a follow-up appointment in primary care, proactive regular dosing with daily controller therapy and an understanding of a patient's beliefs and perceptions about asthma to maximise future self-management.

Introduction: Although adverse events (AEs) from oral corticosteroids (OCS) are well documented, few studies have captured patient perspectives on OCS use. Aims: To characterise patient and healthcare professional (HCP) perception of OCS and AE burden and how these correlate; to assess the impact of AEs on patient adherence. Methods: Pre-defined terms were used to search PubMed in December 2020 for publications reporting patient perceptions of OCS in inflammatory conditions, with no limit on publication year/type. Relevant full texts were reviewed and qualitatively analysed. Results: Of 4763 unique publications identified; 13 were included. Patients receiving OCS for asthma long- (≥6/12 months; n=58) and short-term (≥2 course of >3 days; n=107) ranked OCS as efficacious (8/10) but satisfaction with information from HCPs on AEs was low (4/10). Only 37% reported full adherence; fear of AEs was the main reason (53%) for nonadherence; safety concerns and lack of information were linked with nonadherence and self-medication across studies. Patients consistently reported neuropsychiatric AEs and weight gain as important/prevalent AEs. One study found insomnia and mood disorder (55%; 42%) were most commonly reported after <15-days exposure, while lipodystrophy and weight gain (60%; 60%) were most prevalent at >6 months OCS. Conversely, one study reported only 27% HCPs vs 56% patients recognised neuropsychiatric AEs as most bothersome (P=0.03). Conclusions: Neuropsychiatric AEs are of great concern to patients but may not be adequately acknowledged by HCPs. Fear of AEs and lack of information drive nonadherence. To enable shared decision-making and improve adherence, HCPs should discuss risk:benefit of OCS with patients. Funding: GSK