b'VA Outlines Stepwise Treatment for Asthma-COPD Overlap SyndromeSource: VAprovides better control for patients byIgE may benefit from immunotherapypatients on theophylline require routine targetingmultiplepathwaystokeeporimmunomodulatingmonoclonalmonitoring of serum levels and should be the airways open. A recent study pre- antibodytherapy,accordingtothemanaged by a specialist, as it is associ-sented at the Western Society of Allergy,algorithm. ated with a number of potentially severe Asthma, and Immunology 2020 AnnualPatients with evidence of more Typeadverse reactions including arrhythmias, Scientific Session in Hawaii found that2inflammationtheonesmostlikelydelirium, seizures and death.adding the LAMA tiotropium bromideto respond to these newer therapies,1Rivera AC, Powell TM, Boyko EJ, et al. to ICS and LABA therapy led to fewerAlbertson noted. New-Onset Asthma and Combat Deployment: asthma-related exacerbations than sim- TheVA/DoDClinicalPracticeFindings From the Millennium Cohort Study. plyincreasingthedoseofICSandGuidelineforthePrimaryCareAm J Epidemiol. 2018;187(10):2136-2144. LABA. 4 Management of Asthma urges primarydoi:10.1093/aje/kwy112. PatientswithsevereACOSoftencare practitioners to consult a pulmon- 2Global Initiative for Asthma/Global Initiative prove refractory to inhaled corticoste- ologist or allergist before recommend- for Chronic Obstructive Lung Disease. Diagno-roids and need additional medications.ing any of the five U.S. Food and Drugsis of Diseases of Chronic Airflow Limitation: Options to try include phosphodiester- Administration-approvedbiologicAsthma, COPD and Asthma-COPD Overlap ase inhibitors, chronic macrolides andagentsforasthmaorACOSomali- Syndrome (ACOS). 2015.leukotriene receptor antagonists or leu- zumab,mepolizumab,benralizumab,3Albertson TE, Chenoweth JA, Pearson SJ, Murin S. The Pharmacological Management kotriene synthesis inhibitors. reslizumabanddupilumab.Patientsof Asthma-Chronic Obstructive Pulmonary IntheclinicaltreatmentoftheneedingthesemedicationsshouldbeDisease Overlap Syndrome (ACOS). Expert ACOS patient, the phenotypical mani- referred to specialty care. Opin Pharmacother. 2020 Feb;21(2):213-231.festations of that patient should driveBased on the algorithm, non-Type 24Chipps B, Mosnaim G, Mathur SK, Shaikh thenextpharmacologicalsteps,theinflammationpatientsmaybebetterA, Khoury S, Gopalan G, Palli SR, Lam-authors wrote. servedbytryingmedicationsusedtoerato L, Casciano J, Dotiwala Z, Settipane Those with evidence of Type 2 inflam- reduce exacerbations in COPD patientsR. Add-on tiotropium versus step-up inhaled matory pathway activation, atopic dis- suchasroflumilast,theophyllineorcorticosteroid plus long-acting beta-2-agonist in real-world patients with asthma. Allergy ease of the airways with elevated spu- macrolide antibiotics. and Asthma Proceedings. 2020 May 15. DOI: tum or blood eosinophils and elevatedThe VA/DoD guidelines caution that10.2500/aap.2020.41.200036.102020 COMPENDIUM OF FEDERAL MEDICINE'