GOT LACTOSE? If your treatment regimen includes a dry powder inhaler (DPI), your answer may be yes. In a recent conversation, a colleague alerted me to the fact that at his facility, Symbicort was not being prescribed for patients with lactose allergies. I thought, “Wow, who knew?!” As I began digging a bit further, I discovered that a number of DPIs (Advair, Symbicort and the newly approved 24 hour long-acting beta2 adrenergic-agonist treatment for COPD, Arcapta) all contain lactose as an inactive ingredient used for bulking purposes. While the amounts are minuscule, according to the package inserts, and not likely to affect those with lactose intolerance, (nothing like eating a large bowl of ice cream!), it is a consideration for those prescribing, administering or taking DPIs, especially when a severe lactose allergy is reported. For me this underscores two important basics: first, the need of a thorough patient history and second, READ THE LABEL!