Introduction: Asthma poses a significant burden for the Australian population. Understanding severe exacerbation rates, and steroid-related burden for adults diagnosed with asthma stands to offer insights into how this could be reduced., Methods: Electronic medical records (EMR) and questionnaires from the Optimum Patient Care Research Database Australia (OPCRDA) were utilised retrospectively. OPCRDA is a real-world database with >800,000 medical records from Australian primary care practices. Outcomes were severe asthma exacerbations in Australian adults, over a 12-month period, stratified by Global Initiative for Asthma (GINA) treatment intensity steps, and steroid associated comorbidities., Results: Of the 7868 adults treated for asthma, 19% experienced at least one severe exacerbation in the last 12-months. Severe exacerbation frequency increased with treatment intensity (≥1 severe exacerbation GINA 1 13%; GINA 4 23%; GINA 5a 33% and GINA 5b 28%). Questionnaire participants reported higher rates of severe exacerbations than suggested from their EMR (32% vs 23%) especially in steps 1, 4 and 5. Patients repeatedly exposed to steroids had an increased risk of osteoporosis (OR 1.95, 95% CI 1.43-2.66) and sleep apnoea (OR 1.78, 95% CI 1.30-2.46)., Conclusion: The Australian population living with GINA 1, 4, 5a and 5b asthma have high severe exacerbation rates and steroid-related burden, especially when compared to other first world countries, with these patients needing alternative strategies or possibly specialist assessment to better manage their condition., Competing Interests: Kerry L. Hancock has received speakers’ fees, consulting honoraria and/or travel grants from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Menarini Australia, Mylan and Novartis. Sinthia Bosnic-Anticevich has received honorarium for participation in expert advisory boards and given lectures for Teva Pharmaceuticals, AstraZeneca, GSK, Meda, Mundipharma, Sanofi, Mylan and received unrestricted research grants from Mylan, AstraZeneca, Teva and Mundipharma International. John D. Blakey has received speaker fees and/or consulting fees from Chiesi, Sanofi Boehringer Ingelheim and GSK, and his institution has received income from his activity from AstraZeneca and GSK all for unrelated projects. He has received investigator-initiated research funding from Novartis, and research support-in-kind from GSK, Boehringer Ingelheim and Teva. He is a medical advisor for Asthma Australia for which his institution receives income. Li Ping Chung has received speaker and consultancy fees and conference expenses from AstraZeneca, Novartis, GSK, Boehringer Ingelheim and Menarini. Claude Farah has received honoraria from Boehringer Ingelheim, AstraZeneca, GSK, and Sanofi for attending and speaking at educational meetings and advisory boards. Biljana Cvetkovski has received honorarium for participation in expert advisory boards and given presentations for Sanofi and GSK. Mark Hew declares grants and other advisory board fees (made to his institutional employer) from AstraZeneca, GlaxoSmithKline, Novartis, Sanofi, and Seqirus, for unrelated projects. Anita Sharma is a practising Primary Care Physician and Senior Lecturer, School of Clinical Medicine-Primary Care Clinical Unit, University of Queensland. She supervises clinical training of primary care doctors and serves on advisory boards for Diabetes, Heart Failure and Osteoporosis for Novartis, Merck Sharp & Dohme and Boehringer Ingelheim, Eli Lilley and Amgen. Peter K Smith has advisory board membership with Meda, Nestle Nutrition Institute and Sanofi. He has an unrestricted funding for investigator-initiated studies with Meda. He does not have stock options. Philip J Thompson served on advisory boards & provided consultancies for Astra Zeneca, CSL Behring, Boehringer Ingelheim, Grifols, GSK, and Novartis. In the last 12 months, he received honoraria from GSK for presentations. Russell Wiseman has received consulting honoraria and travel grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Menarini Australia, and Novartis. John W. Upham has received speaker fees and consulting fees from Novartis, AstraZeneca, GSK, Sanofi, and Boehringer Ingelheim. Kwok Y Yan has received honoraria for participation in expert advisory boards and presentations for AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis and StallergenesGreer. Scott Claxton, Eve Denton, Joe Doan, Peter Del Fante, Lucy Morgan, Kanchanamala Ranasinghe, and Deb Stewart declare no conflict of interest. Victoria Carter is an employee of Optimum Patient Care Global and has 5% shareholding of Optimum Patient Care Australia, who is a part-funder of the ACAER Asthma program initiative and this study. Kiranjeet Dhillon, Florian Heraud, Thao Le and Rebecca Vella are employees of Optimum Patient Care Australia, who is a part-funder of the ACAER Asthma program initiative and this study. David Price has advisory board membership with AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Thermofisher; consultancy agreements with Airway Vista Secretariat, AstraZeneca, Boehringer Ingelheim, Chiesi, EPG Communication Holdings Ltd, FIECON Ltd, Fieldwork International, GlaxoSmithKline, Mylan, Mundipharma, Novartis, OM Pharma SA, PeerVoice, Phadia AB, Spirosure Inc, Strategic North Limited, Synapse Research Management Partners S.L, Talos Health Solutions, Theravance and WebMD Global LLC; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Theravance and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals and Sanofi Genzyme; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, Novartis, Thermofisher; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp which develops adherence monitoring technology; is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. The authors report no other conflicts of interest in this work., (© 2022 Hancock et al.)