Abstract Rationale Asthma remains a leading cause of preventable morbidity despite established management strategies. The Global Initiative for Asthma (GINA) since 2019 recommends inhaled corticosteroid (ICS)-containing regimens across all severities to reduce exacerbation risk and improve control. In practice, adherence to these recommendations varies due to provider prescribing patterns, patient preferences, and insurance or formulary limitations that restrict access to optimal medications. Understanding real-world adherence patterns and their impact on outcomes is essential for improving care. This study aims to assess GINA guideline adherence among asthma patients and examine its association with asthma exacerbations. Methods A retrospective analysis was conducted of adult asthma patients seen at UF Health Jacksonville between January 2025 and October 2025. Data was extracted from electronic medical records, including demographics, prescribed therapies, and exacerbation frequency. Patients were categorized into three groups: Adherent (therapy consistent with GINA’s primary recommended pathway), Alternative (patients receiving treatment along alternative track outlined within GINA guidelines but not on ICS containing reliever medications), and Non-Adherent (therapy inconsistent with GINA principles). The primary outcome was the number of asthma exacerbations per patient during the previous year. This is an ongoing study, and additional data collection is underway to expand the cohort and strengthen the analysis. Results Fifty patients were reviewed: 11 (22%) were adherent, 32 (64%) followed an alternative pathway, and 7 (14%) were non-adherent. A total of 23 exacerbations were documented. Among adherent patients, 3 of 11 (27%) experienced exacerbations (1 had 1, 2 had ≥2). In the alternative group, 15 of 32 (47%) experienced exacerbations (3 had 1, 12 had ≥2). Among non-adherent patients, 5 of 7 (71%) had exacerbations (4 had 1 and 1 had ≥2). Patients on alternative or non-adherent regimens demonstrated higher frequency and severity of exacerbations compared to those fully adherent to GINA guidelines. Conclusion Only one in five patients were fully adherent to GINA guidelines. Partial or non-adherence was associated with more frequent exacerbations. Ongoing data collection will enhance statistical strength and allow subgroup analysis. Enhancing provider education and implementing adherence-support strategies may improve asthma control and reduce exacerbation burden, especially when combined with efforts to address insurance and access limitations. This abstract is funded by: None
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