SESSION TITLE: Allergy and Airway Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Asthma is one of the most common chronic diseases in the adult population. Despite the steady increase in the prevalence of asthma, the pathophysiology remains poorly understood. In the United States despite recent advancements, many patients with severe asthma remain uncontrolled. We present a retrospective observational study of hospital admissions for severe asthma exacerbations at a community teaching hospital. Our analysis focused on: patient demographic, racial-socioeconomic factors, overall change in asthma management on discharge and the impact of obesity on outcomes. METHODS: Patients older than 18 years of age admitted with a primary diagnosis of asthma exacerbation were identified using appropriate ICD-10 codes (International Classification of Diseases, Tenth Revision, Clinical Modification) from the electronic medical records. A total of 145 patient charts were selected for the final analysis. Chi-2 test was used to calculate statistical difference in proportions. RESULTS: The mean age of patients was 51.3 years, 77% (111) were female and 23% (34) were male. The racial distribution was 45% African-American, 27% caucasian, and 21% not specified. The mean length of stay (LOS) was 4.51 days (national average of 3.9 days). 50% of patients were obese, 15% had a history of intubation, and 29% were active smokers. 50% of patients were on long-acting beta-agonist/inhaled corticosteroid inhalers (LABA/ICS) on admission. Therapies on discharge: systemic steroids (99%), LABA/ICS (81%), long-acting muscarinic antagonist inhaler (LAMA) (21%), biologic agents (5%). The 30-day hospital readmission rate was 4%. Emergency-Department-visit at 30 days (ED30) was 17% while Emergency-Department-visit at 90 days (ED90) was 24%. Obese patients had significantly increased ED30 as compared to non-obese (23.61% vs 9.59%, p 0.02). Overall, discharge on LABA-ICS did not have an effect on ED30 and ED90. However, on subgroup analysis, stepping-up therapy from ICS to LABA/ICS in African-American patients showed a trend towards decreasing ED30 (16.67% vs 22.72%, p 0.56) and ED90 (16.67% vs 27.27%, p 0.32). CONCLUSIONS: About 1 in 4 patients admitted with asthma-exacerbation had a revisit at the ED within 90 days. Obese patients are more likely to have 30 day ED visit post discharge. Step up therapy to LABA/ICS in African-American population may have a benefit in reducing ED visits post discharge. CLINICAL IMPLICATIONS: Our study indicates that despite appropriate therapy most of the patients hospitalized for asthma exacerbation remain uncontrolled after hospital discharge. The future of severe asthma care must focus on identifying differences among asthma phenotypes and highly individualized asthma treatment. Obesity is a predictor of poor asthma control and high utilization of resources (ED visits). Stepping-up inhaler therapy early may be beneficial especially among the adult African-American population. DISCLOSURES: No relevant relationships by Momcilo Durdevic, source=Web Response No relevant relationships by Dragana Durdevic, source=Web Response No relevant relationships by Amrah Hasan, source=Web Response No relevant relationships by Priscilla Hirst, source=Web Response No relevant relationships by Stephen Jesmajian, source=Web Response No relevant relationships by Ashutossh Naaraayan, source=Web Response No relevant relationships by Abhishek Nimkar, source=Web Response No relevant relationships by Suraj Parikh, source=Web Response No relevant relationships by Andreea Constanta Stan, source=Web Response