The review attempts to consider the existing and new therapeutic interventions to the management of ACO, with regard to the use of corticosteroid therapies with either conventional ICS and new steroid-based interventions known as SGRMs. This paper aims to point out the new developments in the ACO management process giving clinicians understanding related to individualised treatment methods aimed to optimise patient outcomes and reduce the negative effects of ACO management.

ACO is a disorder that makes people have asthma and COPD symptoms, which results in more severe disease progression and higher levels of healthcare consumption. This overlap will be featured by mixed airway inflammation and augmented inflammatory reaction. Although traditional ICS treatments are commonly deployed to manage the inflammatory process, it is accompanied by a lot of side effects, especially in COPD patients. Thus, there is a new generation of drugs including SGRMs and biologic agents that target certain inflammatory pathways which are under investigation as possible solutions to the distinct pathophysiology of ACO.

The review critically evaluates the old and new steroid drugs, their mechanism, efficacy, and side effects. The role of biologics in ACO and their potential is highlighted and their importance in targeting of eosinophilic inflammation is emphasised. Besides that, innovative inhaler preparations and systems of drug delivery are also mentioned to enhance accuracy and effectiveness of ACO treatment. The review summarizes the information in clinical trials and recent researches to present an evidence-based introduction to the current practises.

The results have shown that although ICS remain highly important in controlling ACO, their application should be highly customised to the patients with regard to their individual inflammation patterns. SGRMs have potential to minimise side effects and also target inflammation successfully. Besides, biologic therapies, such as monoclonal antibodies have been promising in the treatment of eosinophilic inflammation, which is a common occurrence in ACO patients. The newer forms of drug delivery, like electronic inhalers are enhancing patient compliance and clinical outcomes.

ACO is one of the complicated conditions that necessitate treatment planning. Although standard ICS treatment has been proven successful in the majority of patients, the emergence of new drugs like SGRMs and biologics has seen the prospects of greater success in the treatment of this disease. They should also consider personalised medicine in future research, where biomarkers and sophisticated diagnostic tools can be used to narrow down treatment methods, which will eventually increase the quality of life of the patient and decrease the number of people overwhelming health care systems.