b'VA Outlines Stepwise TreatmentFor Asthma-COPD Overlap SyndromeBy Annette M. BoyleRespiratory illnesses account for a significant proportion of all noncombat diagnoses among active duty forces andSysteminSacramentorecentlypub-veterans deployed to southwest Asia; past research estimateslishedrecommendationsforthestep-that more than 3% of all veterans who served in this theaterwise treatment of ACOS. 3They noted that, in general, asthma is had newly diagnosed asthma, and a similar percentage werecharacterizedbyallergicsensitization diagnosed with chronic obstructive pulmonary disease. How toand T helper cell 2 lymphocytes (Th2)/eosinophil-mediatedimmuneairway treat those patients is even more difficult when the conditionsresponse. In contrast, COPD more typi-overlap. Thats why the VA has developed recommendationscally features a T helper cell 1 (Th1)/neutrophil-mediatedinflammatory for the stepwise treatment of asthma-COPD overlap syndrome. process.Eosinophilic/Th2-mediated or Type 2 airway inflammation that also involves Type2innatelymphoidcells(ILC2) SACRAMENTO, CADistinguishingfound that more than 3% of all veteransappears to also play an important role in asthmafromchronicobstructivepul- who served in this theater had newlymany asthmatics (Type 2) and in a sub-monary disease (COPD) can pose chal- diagnosedasthma. 1Asimilarnumbergroup of COPD patients that also have lenges for even experienced physicians.ofveteranshavechronicobstructiveasthma/atopicfeatures,theauthors Correctlydiagnosingasthma-COPDpulmonary disease. said. ACOS patients often have this type overlapsyndromecanproveharderAnumberofprofessionalsocietiesof inflammation.still. andinternationalorganizationshave Fifteenpercentto55%ofpatientsdevelopedtheirowndefinitionsforT reaTmenTr ecommendaTionswithachronicobstructiveairwaysACOS, usually a mix of criteria includ- The critical first step in the treatment disease have ACOS, depending on theingpatienthistory,spirometryandofanypatientwithCOPDor ACOS definitionsusedandthepopulationsymptoms. Amoredetailedanduni- is to stop smoking or vaping nicotine studied. These patients typically haveformlyaccepteddefinitionofACOSand marijuana, the authors said. While worse outcomes than those who haveremainselusive,asdoesastandardsmokingcessationisnotoriouslydif-either asthma or COPD alone.treatment protocol. 2 ficult for many patients, a number of FortheVA,properlydiagnosingIt is a syndrome with various phe- productsandmedicationscanhelp, andtreatingACOSisparticularlynotypes,TimothyAlbertson,MD,includingnicotinegumsandpatches, important.RespiratoryillnesseshaveUniversityofCalifornia,Davis,innortriptyline, bupropion, cytosine and accountedforasignificantpropor- Sacramento, CA, told U.S. Medicine. varenicline.tionofallnoncombatdiagnosesDespite the variation in presentation,PatientswithACOSalsoshould among active duty forces and veteransAlbertsonandhiscolleaguesfromreceive annual influenza vaccines and deployed to southwest Asia. ResearchUniversity of California Davis and thethe13-and23-valentpneumococcal fromtheMillenniumCohortStudyVANorthernCaliforniaHealthCarevaccines.8 2020 COMPENDIUM OF FEDERAL MEDICINE'