Table 2 Pharmacological therapy for ACOS

SABA

Widely used bronchodilators in the management of COPD and asthma

[20, 88]

LABA/ICS

Several studies showed positive results in ACOS patients when LABA are combined with ICS

[60, 76]

ICS

Controversial and depends on the patient. High sputum eosinophil counts and bronchial wall thickening on chest high-resolution computed tomography may be used as predictors in ACOS patients

[60, 76,77,78]

LRA

Showed positive results in asthma patients who smoke

[79]

MCS

Are used in the management of allergic asthma and recent data indicate that mast cells may also play an important role in COPD

[89, 90]

Xanthines

Theophylline can modulates corticosteroid activity and the efficacy of ICS

[91]

LAMA

Significantly improves lung function and quality of life in COPD. Improves lung function in patients with inadequately controlled asthma

[75, 92]

PDEI

Positive results in the management of COPD and asthma. Combination with ICS and montelukast shows beneficial positive effect. Enhanced efficacy of the concomitant ICS/LABA/LAMA therapy

[80,81,82,83,84,85]

anti-IgE

Several studies demonstrated the effectiveness of omalizumab in ACOS patients particularly decreased IL-4, allergic and pulmonary symptoms and migraine attacks

[86, 87]