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Which of the following is most characteristic of bronchiolitis obliterans?
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Teaching Points
- Bronchiolitis obliterans (BO) is characterized by progressive airflow limitation and fibroproliferative thickening of bronchiolar walls. It occurs as a manifestation of rejection in lung transplant recipients as well as in response to inhalational injuries. Therapy for BO is limited.
- For transplant patients with BO, some recommend augmentation of immunosuppression, steroids, and cytolytic therapy.The majority of individuals contract opportunistic infections. This is the most common cause of death.
- When pulmonary function tests are performed, there is decreased air flow during expiration, and reflects as a decreased FEV1, due to the narrowing of the bronchiolar lumen from the fibro proliferative thickening of the walls. Decreased FEV1 is the most diagnostic of BO.
- Spirometry classically shows obstructive flow pattern with decreased FEV1/FVC as well.
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PubMed References
| An international ISHLT/ATS/ERS clinical practice guideline: summary for clinicians. Bronchiolitis obliterans syndrome complicating lung transplantation., Welsh CH,Wang TS,Lyu DM,Orr J,Meyer KC,Glanville AR,Verleden GM,Wilson KC,Thomson CC,The American Thoracic Society Implementation Task Force,, Annals of the American Thoracic Society, 2015 Jan [PubMed PMID: 25635657] | |
| An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome., Meyer KC,Raghu G,Verleden GM,Corris PA,Aurora P,Wilson KC,Brozek J,Glanville AR,, The European respiratory journal, 2014 Dec [PubMed PMID: 25359357] | |
| Occupational causes of constrictive bronchiolitis., Kreiss K,, Current opinion in allergy and clinical immunology, 2013 Apr [PubMed PMID: 23407121] | |
| Obliterative bronchiolitis., Barker AF,Bergeron A,Rom WN,Hertz MI,, The New England journal of medicine, 2014 May 8 [PubMed PMID: 24806161] | |
| The mechanism of respiratory failure in paraneoplastic pemphigus., Nousari HC,Deterding R,Wojtczack H,Aho S,Uitto J,Hashimoto T,Anhalt GJ,, The New England journal of medicine, 1999 May 6 [PubMed PMID: 10228191] | |
| Fluticasone, Azithromycin, and Montelukast Treatment for New-Onset Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation., Williams KM,Cheng GS,Pusic I,Jagasia M,Burns L,Ho VT,Pidala J,Palmer J,Johnston L,Mayer S,Chien JW,Jacobsohn DA,Pavletic SZ,Martin PJ,Storer BE,Inamoto Y,Chai X,Flowers ME,Lee SJ,, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2016 Apr [PubMed PMID: 26475726] | |
| A randomised controlled trial of azithromycin therapy in bronchiolitis obliterans syndrome (BOS) post lung transplantation., Corris PA,Ryan VA,Small T,Lordan J,Fisher AJ,Meachery G,Johnson G,Ward C,, Thorax, 2015 May [PubMed PMID: 25714615] | |
| Fluticasone, Azithromycin, and Montelukast Treatment for New-Onset Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation., Williams KM,Cheng GS,Pusic I,Jagasia M,Burns L,Ho VT,Pidala J,Palmer J,Johnston L,Mayer S,Chien JW,Jacobsohn DA,Pavletic SZ,Martin PJ,Storer BE,Inamoto Y,Chai X,Flowers ME,Lee SJ,, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2016 Apr [PubMed PMID: 26475726] | |
| Fluticasone, azithromycin and montelukast therapy in reducing corticosteroid exposure in bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: a case series of eight patients., Norman BC,Jacobsohn DA,Williams KM,Au BK,Au MA,Lee SJ,Moravec CK,Chien JW,, Bone marrow transplantation, 2011 Oct [PubMed PMID: 21132024] | |
| Azithromycin reverses airflow obstruction in established bronchiolitis obliterans syndrome., Yates B,Murphy DM,Forrest IA,Ward C,Rutherford RM,Fisher AJ,Lordan JL,Dark JH,Corris PA,, American journal of respiratory and critical care medicine, 2005 Sep 15 [PubMed PMID: 15976371] | |
| A prospective interventional study on the use of extracorporeal photopheresis in patients with bronchiolitis obliterans syndrome after lung transplantation., Jaksch P,Scheed A,Keplinger M,Ernst MB,Dani T,Just U,Nahavandi H,Klepetko W,Knobler R,, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2012 Sep [PubMed PMID: 22884382] | |
| A randomised controlled trial of azithromycin to prevent chronic rejection after lung transplantation., Vos R,Vanaudenaerde BM,Verleden SE,De Vleeschauwer SI,Willems-Widyastuti A,Van Raemdonck DE,Schoonis A,Nawrot TS,Dupont LJ,Verleden GM,, The European respiratory journal, 2011 Jan [PubMed PMID: 20562124] | |
| Obliterative (constrictive) bronchiolitis., Lynch JP 3rd,Weigt SS,DerHovanessian A,Fishbein MC,Gutierrez A,Belperio JA,, Seminars in respiratory and critical care medicine, 2012 Oct [PubMed PMID: 23001805] | |
| Survival after bronchiolitis obliterans syndrome among bilateral lung transplant recipients., Finlen Copeland CA,Snyder LD,Zaas DW,Turbyfill WJ,Davis WA,Palmer SM,, American journal of respiratory and critical care medicine, 2010 Sep 15 [PubMed PMID: 20508211] |
