{
  "schemaVersion": 2,
  "eyebrow": "Transplant Pulmonology",
  "title": "Bronchiolitis Obliterans",
  "summary": "Bronchiolitis obliterans is an irreversible small-airway fibrotic syndrome most often encountered after lung or allogeneic hematopoietic stem-cell transplantation. Early spirometric decline, infection exclusion, and transplant-team evaluation are central because established airflow obstruction is difficult to reverse.",
  "seoDescription": "Physician guide to bronchiolitis obliterans after lung or allogeneic stem-cell transplantation, emphasizing surveillance, spirometry, prognosis, and evidence limits.",
  "clinicalQuestion": "How should physicians recognize, monitor, and manage suspected bronchiolitis obliterans after lung or allogeneic hematopoietic stem-cell transplantation?",
  "specialty": "Pulmonology and Transplant Medicine",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "bronchiolitis obliterans",
    "bronchiolitis obliterans syndrome",
    "BOS",
    "chronic graft-versus-host disease",
    "allogeneic hematopoietic stem cell transplantation",
    "lung transplantation",
    "spirometry"
  ],
  "keyTakeaways": [
    "After allogeneic hematopoietic stem-cell transplantation, bronchiolitis obliterans syndrome is closely linked to chronic graft-versus-host disease and generally develops within 2 years. [1]",
    "New obstructive physiology on pulmonary function testing is the central clinical basis for bronchiolitis obliterans syndrome; declining FEV1 may precede established obstruction. [1][4]",
    "Established post-transplant bronchiolitis obliterans syndrome is commonly irreversible despite immunosuppressive treatment, making surveillance and prompt investigation of functional decline high-value. [1]",
    "Do not use azithromycin prophylaxis after allogeneic hematopoietic stem-cell transplantation to prevent airflow decline; the ALLOZITHRO randomized trial evaluated this strategy in this setting. [1]",
    "Evidence for treatment remains limited; a 2024 ERS/EBMT clinical practice guideline addresses pulmonary chronic graft-versus-host disease in adults, and management should be coordinated with transplant and pulmonary specialists. [22]"
  ],
  "sections": [
    {
      "id": "clinical-context",
      "eyebrow": "Clinical Context",
      "heading": "Recognize the relevant bronchiolitis obliterans phenotype",
      "intro": "The term has distinct clinical uses that should not be conflated.",
      "paragraphs": [
        "Bronchiolitis obliterans is a small-airway injury syndrome characterized pathologically by bronchiolar inflammation and fibrosis that narrows or obliterates terminal airways, producing progressive airflow obstruction. Airway epithelial injury and chronic intrapulmonary inflammation are implicated in environmental and occupational disease. [2][18]",
        "In transplant practice, bronchiolitis obliterans syndrome (BOS) is a clinical syndrome defined by airflow obstruction rather than a requirement for surgical-pathologic confirmation. It occurs after lung transplantation and after allogeneic hematopoietic stem-cell transplantation (HSCT), where it is a pulmonary manifestation of chronic graft-versus-host disease (cGVHD). [1][4][11][18]",
        "Keep post-HSCT BOS distinct from the pediatric acute viral bronchiolitis guideline literature, which addresses a different disease and does not inform BOS treatment. [21]"
      ],
      "bullets": [],
      "subsections": [],
      "table": {
        "caption": "Clinical settings in which the bronchiolitis obliterans label has materially different implications. [1][2][4][11][18]",
        "columns": [
          "Setting",
          "Clinical implication"
        ],
        "rows": [
          [
            "Allogeneic HSCT",
            "BOS is linked to cGVHD and presents as new obstructive pulmonary function abnormality, often within 2 years after transplantation. [1][4]"
          ],
          [
            "Lung transplantation",
            "BOS denotes obstructive chronic lung allograft dysfunction and is staged clinically using spirometric data. [8][11]"
          ],
          [
            "Environmental or occupational exposure",
            "Epithelial injury and chronic intrapulmonary inflammation are central pathogenic considerations; exposure history can direct etiologic investigation. [2]"
          ]
        ]
      }
    },
    {
      "id": "case-finding",
      "eyebrow": "Detection",
      "heading": "Find airflow decline before fixed obstruction is advanced",
      "intro": "Symptoms alone are an insensitive trigger for evaluation in transplant recipients.",
      "paragraphs": [
        "In allogeneic HSCT recipients, obtain and trend spirometry because an FEV1 decrease may occur before overt obstructive lung disease. New cough, dyspnea, increased oxygen requirement, a reduced pulmonary-function result, or abnormal high-resolution CT findings should prompt focused evaluation. [1][9]",
        "Pediatric guidance consistently endorses pulmonary-function-test surveillance after HSCT, although reported recommended intervals range from every 3 months to annually during the first post-transplant year. This heterogeneity supports using the responsible transplant program's surveillance pathway rather than assuming a universally established interval. [7]",
        "Children must be able to perform reproducible pulmonary function testing for BOS criteria to be applicable; this is generally feasible after approximately age 5 years. [10]"
      ],
      "bullets": [
        "Compare spirometry with the patient's prior post-transplant values; a trajectory of FEV1 decline is clinically meaningful even before a new obstructive pattern is fully established. [1]",
        "In a symptomatic or declining patient, involve transplant pulmonology and the transplant team early; established disease has limited reversibility. [1][20]",
        "Use high-resolution CT and infection-directed assessment selectively as part of the evaluation of symptoms or physiologic decline; published biopsy practice has incorporated symptoms, pulmonary function, and HRCT findings. [9]"
      ],
      "subsections": [],
      "table": null
    },
    {
      "id": "diagnostic-approach",
      "eyebrow": "Diagnosis",
      "heading": "Anchor the diagnosis in physiology and exclude competing causes",
      "intro": "BOS is a clinical diagnosis; biopsy is not routinely required to establish it.",
      "paragraphs": [
        "For post-HSCT disease, the defining clinical signal is new obstructive lung disease on pulmonary function testing in the appropriate transplant and cGVHD context. For lung allograft recipients, BOS remains a spirometry-based clinical entity within obstructive chronic lung allograft dysfunction. [1][4][8][11]",
        "The supplied sources do not provide sufficiently detailed consensus thresholds for FEV1, FEV1/FVC, residual volume, or imaging criteria. Avoid applying uncited numeric cutoffs from memory when using this evidence set; use current transplant-specific consensus criteria and interpret results against the patient's baseline. [20][22]",
        "Do not equate an obstructive spirometric pattern automatically with BOS. Infection, acute allograft or airway processes, medication effects, and alternative structural or parenchymal disease require assessment in the relevant transplant context. This is especially important because symptoms, oxygen requirement, pulmonary-function decline, and HRCT abnormalities have all been used to select patients for lung biopsy in published post-HSCT cohorts. [9]"
      ],
      "bullets": [
        "Review pre- and post-transplant spirometric trajectories rather than relying on a single test. [1]",
        "Assess for concurrent cGVHD manifestations in allogeneic HSCT recipients because BOS is closely associated with cGVHD. [1][4]",
        "Reserve biopsy decisions for multidisciplinary discussion when a competing diagnosis would alter treatment; the available evidence describes clinically directed biopsy, not routine diagnostic biopsy. [9]"
      ],
      "subsections": [],
      "table": null
    },
    {
      "id": "management",
      "eyebrow": "Management",
      "heading": "Treat as a transplant complication with limited evidence for reversal",
      "intro": "Management priorities differ between prevention, early detection, and established disease.",
      "paragraphs": [
        "Established BOS after HSCT is generally considered irreversible despite immunosuppressive therapy. Treatment should therefore prioritize confirmation of the phenotype, evaluation for remediable competing processes, control of associated cGVHD, serial pulmonary-function assessment, and specialist-directed optimization of immunosuppression and supportive care. [1][20][22]",
        "Systemic glucocorticoids were endorsed as first-line systemic treatment in an earlier consensus discussion, but the available search results also emphasize poor response to corticosteroids or immunosuppressants and the absence of established treatment approaches. This tension reflects limited and evolving evidence rather than a reliably effective reversal strategy. [3][24]",
        "For adult pulmonary cGVHD, use the 2024 ERS/EBMT clinical practice guideline as the current guideline anchor and coordinate decisions with the transplant center. The supplied excerpts do not provide its specific recommendations, agent selection, or dosing; these should not be reconstructed from the citations here. [22]"
      ],
      "bullets": [
        "Do not start azithromycin solely as prophylaxis against post-allogeneic-HSCT airflow decline. The ALLOZITHRO randomized clinical trial examined azithromycin prophylaxis in this population. [1]",
        "Do not extrapolate lung-transplant prevention data to HSCT BOS: inhaled fluticasone did not prevent BOS or improve survival in a small randomized lung-transplant trial. [14]",
        "For lung-transplant BOS, optimization of immunosuppression to limit further allograft rejection is a major treatment focus; management is transplant-center specific. [15]"
      ],
      "subsections": [
        {
          "heading": "Therapies with important evidence limits",
          "paragraphs": [
            "Ruxolitinib has been studied in a registered trial for BOS after allogeneic hematopoietic cell transplantation, but the supplied record does not report efficacy, safety, or dosing results. Trial registration alone should not be treated as evidence for routine use. [22]",
            "Reports of successful treatment and newer treatment-option reviews are hypothesis-generating or observational in the supplied results. They cannot establish comparative efficacy or a standardized regimen. [16][17]"
          ],
          "bullets": []
        }
      ],
      "table": {
        "caption": "Evidence-informed management boundaries for post-transplant BOS. [1][3][14][15][22][24]",
        "columns": [
          "Decision",
          "What the available evidence supports",
          "What not to infer"
        ],
        "rows": [
          [
            "Post-HSCT prophylaxis with azithromycin",
            "A randomized trial evaluated azithromycin prophylaxis for airflow decline–free survival after allogeneic HSCT. [1]",
            "Do not use it as routine BOS prophylaxis on the basis of these results. [1]"
          ],
          [
            "Systemic immunosuppression for HSCT-associated BOS",
            "Historical consensus endorsed systemic glucocorticoids as first-line systemic treatment; current adult pulmonary cGVHD guidance is available through ERS/EBMT. [3][22]",
            "Do not promise reversal of established obstruction; response is often poor. [1][24]"
          ],
          [
            "Inhaled fluticasone after lung transplantation",
            "A placebo-controlled trial found no prevention benefit for BOS or survival. [14]",
            "Do not extrapolate a negative prevention trial into evidence about all inhaled regimens or treatment of established disease. [14]"
          ],
          [
            "Lung-transplant BOS",
            "Optimization of immunosuppression to reduce further allograft rejection is a major therapeutic focus. [15]",
            "Do not apply HSCT cGVHD management pathways without transplant-specific review. [1][15]"
          ]
        ]
      }
    },
    {
      "id": "prognosis",
      "eyebrow": "Prognosis",
      "heading": "Communicate the risk of irreversible respiratory decline",
      "intro": "Prognostic estimates vary by transplant population and study era.",
      "paragraphs": [
        "After allogeneic HSCT, BOS has been reported in 4% to 6% of recipients overall and in up to 14% of those with cGVHD. It usually develops within 2 years after transplantation. [1]",
        "A pediatric HSCT trial description cites approximately 40% to 60% mortality and 13% 5-year survival once BOS is diagnosed; these estimates should be communicated cautiously because they derive from a trial background summary rather than a contemporary comparative cohort. [19]",
        "The key prognostic consequence is that airflow obstruction is often progressive and difficult to reverse. This supports active surveillance, early review of FEV1 decline, and timely transplant-center involvement rather than waiting for severe symptomatic limitation. [1][20]"
      ],
      "bullets": [],
      "subsections": [],
      "table": null
    }
  ],
  "faq": [
    {
      "question": "Is bronchiolitis obliterans syndrome the same as chronic graft-versus-host disease?",
      "answer": "After allogeneic HSCT, BOS is closely linked to cGVHD and is regarded as a pulmonary manifestation of cGVHD, but it is identified clinically through new obstructive pulmonary physiology. [1][4][18]"
    },
    {
      "question": "Should azithromycin be prescribed to prevent BOS after allogeneic HSCT?",
      "answer": "No. Azithromycin prophylaxis should not be used solely to prevent post-allogeneic-HSCT airflow decline or BOS; this strategy was evaluated in the ALLOZITHRO randomized trial. [1]"
    },
    {
      "question": "When should a transplant recipient with suspected BOS undergo lung biopsy?",
      "answer": "Biopsy is not required for the clinical BOS construct. Published post-HSCT practice selected biopsy using symptoms, pulmonary-function decline, oxygen need, and/or HRCT abnormalities; use multidisciplinary review when histology would change management. [9][11]"
    },
    {
      "question": "How often should pulmonary function be monitored after pediatric HSCT?",
      "answer": "Pediatric guidelines endorse surveillance, but recommendations cited in the available literature range from every 3 months to annually in the first post-transplant year. Follow the transplant program's protocol and escalate testing for symptoms or declining FEV1. [7][1]"
    }
  ],
  "references": [
    {
      "number": 1,
      "title": "Effect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant:",
      "detail": "jamanetwork.com",
      "url": "https://jamanetwork.com/journals/jama/fullarticle/2647869",
      "authors": "jamanetwork.com",
      "host": "jamanetwork.com"
    },
    {
      "number": 2,
      "title": "Environmental and occupational bronchiolitis obliterans",
      "detail": "www.thelancet.com",
      "url": "https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(23)00325-0/fulltext",
      "authors": "www.thelancet.com",
      "host": "www.thelancet.com"
    },
    {
      "number": 3,
      "title": "What we know and mostly do not know about bronchiolitis ...",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/bmt201138",
      "authors": "www.nature.com",
      "host": "www.nature.com"
    },
    {
      "number": 4,
      "title": "Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/bmt2012241?error=cookies_not_supported",
      "authors": "www.nature.com",
      "host": "www.nature.com"
    },
    {
      "number": 5,
      "title": "Bronchiolitis obliterans following pediatric allogeneic hematopoietic stem cell transplantation | Bone Marrow Transplantation",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/bmt200819?error=cookies_not_supported",
      "authors": "www.nature.com",
      "host": "www.nature.com"
    },
    {
      "number": 6,
      "title": "To Respond or Not to Respond: That's the Question...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/transplantjournal/fulltext/2026/02000/to_respond_or_not_to_respond__that_s_the_question.10.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com"
    },
    {
      "number": 7,
      "title": "Detection of Bronchiolitis Obliterans Syndrome after Pediatric ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/ajrccm/article/210/3/262/8491330",
      "authors": "academic.oup.com",
      "host": "academic.oup.com"
    },
    {
      "number": 8,
      "title": "Quantitative Image Analysis at Chronic Lung...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/transplantjournal/fulltext/2022/06000/quantitative_image_analysis_at_chronic_lung.26.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com"
    },
    {
      "number": 9,
      "title": "Biopsy-Verified Bronchiolitis Obliterans and Other ...",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S1083879114013974",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 10,
      "title": "Bronchiolitis Obliterans - an overview",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/nursing-and-health-professions/bronchiolitis-obliterans",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 11,
      "title": "Bronchiolitis obliterans syndrome is not specific for ...",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1053249814014259",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 12,
      "title": "Management and clinical outcomes after lung ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1111/tid.13084",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 13,
      "title": "Lung transplantation in adults and children: Putting ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/resp.12370",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 14,
      "title": "Addition of inhaled corticosteroids to systemic... : Transplantation",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/transplantjournal/abstract/00007890-200206150-00016~addition-of-inhaled-corticosteroids-to-systemic",
      "authors": "journals.lww.com",
      "host": "journals.lww.com"
    },
    {
      "number": 15,
      "title": "Extracorporeal Photopheresis for Bronchiolitis...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/transplantjournal/fulltext/2018/07000/extracorporeal_photopheresis_for_bronchiolitis.14.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com"
    },
    {
      "number": 16,
      "title": "Successful treatment of severe post hematopoietic stem ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.6267",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 17,
      "title": "Treatment Options for Bronchiolitis Obliterans Secondary to ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/ctr.70274",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 18,
      "title": "Prevalence of Bronchiolitis Obliterans Syndrome (BOS) Following Allogeneic Hematopoietic Stem Cell Transplant (alloHSCT) in the USA, Europe and Japan - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S0006497118636043",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 19,
      "title": "Study Details | NCT03072849 | Early Detection and Management of Bronchiolitis Obliterans Syndrome Following Pediatric Hematopoietic Stem Cell Transplantation | ClinicalTrials.gov",
      "detail": "clinicaltrials.gov",
      "url": "https://clinicaltrials.gov/study/NCT03072849",
      "authors": "clinicaltrials.gov",
      "host": "clinicaltrials.gov"
    },
    {
      "number": 20,
      "title": "How I treat bronchiolitis obliterans syndrome after ...",
      "detail": "ashpublications.org",
      "url": "https://ashpublications.org/blood/article/129/4/448/36179/How-I-treat-bronchiolitis-obliterans-syndrome",
      "authors": "ashpublications.org",
      "host": "ashpublications.org"
    },
    {
      "number": 21,
      "title": "Clinical Practice Guideline: The Diagnosis, Management ...",
      "detail": "pediatrics.aappublications.org",
      "url": "https://pediatrics.aappublications.org/content/134/5/e1474",
      "authors": "pediatrics.aappublications.org",
      "host": "pediatrics.aappublications.org"
    },
    {
      "number": 22,
      "title": "Study Details | NCT03674047 | Ruxolitinib for Bronchiolitis Obliterans Syndrome (BOS) After Allogeneic Hematopoietic Cell Transplantation (HCT) | ClinicalTrials.gov",
      "detail": "clinicaltrials.gov",
      "url": "https://clinicaltrials.gov/study/NCT03674047",
      "authors": "clinicaltrials.gov",
      "host": "clinicaltrials.gov"
    },
    {
      "number": 23,
      "title": "Study Details | NCT01327625 | Efficacy Study of Azithromycin-based Therapy for Bronchiolitis Obliterans | ClinicalTrials.gov",
      "detail": "clinicaltrials.gov",
      "url": "https://clinicaltrials.gov/study/NCT01327625",
      "authors": "clinicaltrials.gov",
      "host": "clinicaltrials.gov"
    },
    {
      "number": 24,
      "title": "Tamibarotene for the Treatment of Bronchiolitis Obliterans ...",
      "detail": "journal.chestnet.org",
      "url": "https://journal.chestnet.org/article/S0012-3692(18)32340-7/fulltext",
      "authors": "journal.chestnet.org",
      "host": "journal.chestnet.org"
    }
  ],
  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
    {
      "number": 1,
      "title": "Effect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant:",
      "detail": "jamanetwork.com",
      "url": "https://jamanetwork.com/journals/jama/fullarticle/2647869",
      "authors": "jamanetwork.com",
      "host": "jamanetwork.com",
      "snippet": "Title: Effect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant:\n# Effect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant: The ALLOZITHRO Randomized Clinical Trial | Infectious Diseases | JAMA | J",
      "score": 0.6688159
    },
    {
      "number": 2,
      "title": "Environmental and occupational bronchiolitis obliterans",
      "detail": "www.thelancet.com",
      "url": "https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(23)00325-0/fulltext",
      "authors": "www.thelancet.com",
      "host": "www.thelancet.com",
      "snippet": "by SS Gutor · 2023 · Cited by 15 — Growing evidence implicates airway epithelial injury and chronic intrapulmonary inflammation as central to disease pathogenesis.1",
      "score": 0.47227025
    },
    {
      "number": 3,
      "title": "What we know and mostly do not know about bronchiolitis ...",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/bmt201138",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "by PJ Martin · 2012 · Cited by 15 — The Regensberg Conference endorsed first-line systemic treatment with glucocorticoids for all patients, with the recommendation that treatment",
      "score": 0.23538111
    },
    {
      "number": 4,
      "title": "Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/bmt2012241?error=cookies_not_supported",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis | Bone Marrow Transplantation. We also use optional cookies for advertising, personalisation of content, usage analysis, and social media, as well as to allow video information to be shared for both market",
      "score": 0.81489426
    },
    {
      "number": 5,
      "title": "Bronchiolitis obliterans following pediatric allogeneic hematopoietic stem cell transplantation | Bone Marrow Transplantation",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/bmt200819?error=cookies_not_supported",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "# Bronchiolitis obliterans following pediatric allogeneic hematopoietic stem cell transplantation. Bronchiolitis obliterans (BrOb) is a well-recognized complication of allogeneic hematopoietic stem cell transplantation (HSCT). ### Clinical risk factors and prognostic model for patients with bronchio",
      "score": 0.68090034
    },
    {
      "number": 6,
      "title": "To Respond or Not to Respond: That's the Question...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/transplantjournal/fulltext/2026/02000/to_respond_or_not_to_respond__that_s_the_question.10.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "Bronchiolitis obliterans syndrome. Although BOS is a well-recognized and clearly defined clinical entity, there are currently no evidence-based treatment",
      "score": 0.6222074
    },
    {
      "number": 7,
      "title": "Detection of Bronchiolitis Obliterans Syndrome after Pediatric ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/ajrccm/article/210/3/262/8491330",
      "authors": "academic.oup.com",
      "host": "academic.oup.com",
      "snippet": "by S Shanthikumar · 2024 · Cited by 35 — Although all current pediatric guidelines recommend PFT surveillance, the recommended frequency ranges from every 3 months to annually in the first year post-",
      "score": 0.5164741
    },
    {
      "number": 8,
      "title": "Quantitative Image Analysis at Chronic Lung...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/transplantjournal/fulltext/2022/06000/quantitative_image_analysis_at_chronic_lung.26.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "by SS Weigt · 2022 · Cited by 14 — Obstructive CLAD, still termed bronchiolitis obliterans syndrome (BOS), is defined as CLAD with associated indices of airflow limitation and without",
      "score": 0.27740982
    },
    {
      "number": 9,
      "title": "Biopsy-Verified Bronchiolitis Obliterans and Other ...",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S1083879114013974",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "by HH Uhlving · 2015 · Cited by 62 — The decision to perform a lung biopsy was based on clinical symptoms (cough, dyspnea, increased oxygen need), reduced PF, and/or pathological findings on HRCT",
      "score": 0.7402687
    },
    {
      "number": 10,
      "title": "Bronchiolitis Obliterans - an overview",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/nursing-and-health-professions/bronchiolitis-obliterans",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "In general, the BOS criteria70 can be used in children who can perform pulmonary function tests reproducibly (i.e., greater that 5 years of age). However",
      "score": 0.6504012
    },
    {
      "number": 11,
      "title": "Bronchiolitis obliterans syndrome is not specific for ...",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1053249814014259",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "by C Towe · 2015 · Cited by 17 — Bronchiolitis obliterans syndrome (BOS) is a clinical diagnosis based on spirometric data that is the accepted standard for staging chronic allograft",
      "score": 0.48996773
    },
    {
      "number": 12,
      "title": "Management and clinical outcomes after lung ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1111/tid.13084",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "idiopathic bronchiolitis obliterans (n = 1). Despite intensive immunosuppression, lung transplant itself assists in disease burden reduction",
      "score": 0.65597594
    },
    {
      "number": 13,
      "title": "Lung transplantation in adults and children: Putting ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/resp.12370",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "by BR Thompson · 2014 · Cited by 12 — ... complications of lung transplantation such as rejection, infection and bronchiolitis obliterans. However, interpretation of spirometry is",
      "score": 0.588062
    },
    {
      "number": 14,
      "title": "Addition of inhaled corticosteroids to systemic... : Transplantation",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/transplantjournal/abstract/00007890-200206150-00016~addition-of-inhaled-corticosteroids-to-systemic",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "transplantjournal-bg-header\n\n# Addition of inhaled corticosteroids to systemic immunosuppression after lung transplantation: a double-blind, placebo-controlled trial1\n\n## Background.\n\nIt is postulated that bronchiolitis obliterans syndrome (BOS) is preceded by airway inflammation that has been descr",
      "score": 0.57666177
    },
    {
      "number": 15,
      "title": "Extracorporeal Photopheresis for Bronchiolitis...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/transplantjournal/fulltext/2018/07000/extracorporeal_photopheresis_for_bronchiolitis.14.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "by R Hachem · 2018 · Cited by 73 — An important focus of treatment of BOS patients is optimizing immunosuppression to prevent further lung allograft rejection. inhaled cyclosporine,",
      "score": 0.49948794
    },
    {
      "number": 16,
      "title": "Successful treatment of severe post hematopoietic stem ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.6267",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "by J Pénichoux · 2022 · Cited by 1 — Successful treatment of severe post hematopoietic stem cell transplantation bronchiolitis obliterans ... immunosuppressive therapy.",
      "score": 0.47329262
    },
    {
      "number": 17,
      "title": "Treatment Options for Bronchiolitis Obliterans Secondary to ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/ctr.70274",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "by A Kalantari · 2025 · Cited by 1 — Immunosuppressive regimens had the highest non-response rate (42%), possibly due to treatment bias. FEV1 change was not statistically different",
      "score": 0.40302688
    },
    {
      "number": 18,
      "title": "Prevalence of Bronchiolitis Obliterans Syndrome (BOS) Following Allogeneic Hematopoietic Stem Cell Transplant (alloHSCT) in the USA, Europe and Japan - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S0006497118636043",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: Prevalence of Bronchiolitis Obliterans Syndrome (BOS) Following Allogeneic Hematopoietic Stem Cell Transplant (alloHSCT) in the USA, Europe and Japan - ScienceDirect\n# 722.Clinical Allogeneic Transplantation: Acute and Chronic GVHD, Immune Reconstitution Prevalence of Bronchiolitis Obliterans",
      "score": 0.60694176
    },
    {
      "number": 19,
      "title": "Study Details | NCT03072849 | Early Detection and Management of Bronchiolitis Obliterans Syndrome Following Pediatric Hematopoietic Stem Cell Transplantation | ClinicalTrials.gov",
      "detail": "clinicaltrials.gov",
      "url": "https://clinicaltrials.gov/study/NCT03072849",
      "authors": "clinicaltrials.gov",
      "host": "clinicaltrials.gov",
      "snippet": "Hildebrandt GC, Fazekas T, Lawitschka A, Bertz H, Greinix H, Halter J, Pavletic SZ, Holler E, Wolff D. Diagnosis and treatment of pulmonary chronic GVHD: report from the consensus conference on clinical practice in chronic GVHD. Bone Marrow Transplant. 2011 Oct;46(10):1283-95. doi: 10.1038/bmt.2011.",
      "score": 0.69573146
    },
    {
      "number": 20,
      "title": "How I treat bronchiolitis obliterans syndrome after ...",
      "detail": "ashpublications.org",
      "url": "https://ashpublications.org/blood/article/129/4/448/36179/How-I-treat-bronchiolitis-obliterans-syndrome",
      "authors": "ashpublications.org",
      "host": "ashpublications.org",
      "snippet": "by KM Williams · 2017 · Cited by 144 — revised consensus diagnostic guidelines are now available, supportive care has improved, there is greater understanding of potential mechanisms of disease, s",
      "score": 0.6944897
    },
    {
      "number": 21,
      "title": "Clinical Practice Guideline: The Diagnosis, Management ...",
      "detail": "pediatrics.aappublications.org",
      "url": "https://pediatrics.aappublications.org/content/134/5/e1474",
      "authors": "pediatrics.aappublications.org",
      "host": "pediatrics.aappublications.org",
      "snippet": "The new clinical practice guidelines for the treatment of bronchiolitis leave no room for the use of albuterol or similar medicines in the treatment of",
      "score": 0.6760432
    },
    {
      "number": 22,
      "title": "Study Details | NCT03674047 | Ruxolitinib for Bronchiolitis Obliterans Syndrome (BOS) After Allogeneic Hematopoietic Cell Transplantation (HCT) | ClinicalTrials.gov",
      "detail": "clinicaltrials.gov",
      "url": "https://clinicaltrials.gov/study/NCT03674047",
      "authors": "clinicaltrials.gov",
      "host": "clinicaltrials.gov",
      "snippet": "Bos S, Murray J, Marchetti M, Cheng GS, Bergeron A, Wolff D, Sander C, Sharma A, Badawy SM, Peric Z, Piekarska A, Pidala J, Raj K, Penack O, Kulkarni S, Beestrum M, Linke A, Rutter M, Coleman C, Tonia T, Schoemans H, Stolz D, Vos R. ERS/EBMT clinical practice guidelines on treatment of pulmonary chr",
      "score": 0.6041426
    },
    {
      "number": 23,
      "title": "Study Details | NCT01327625 | Efficacy Study of Azithromycin-based Therapy for Bronchiolitis Obliterans | ClinicalTrials.gov",
      "detail": "clinicaltrials.gov",
      "url": "https://clinicaltrials.gov/study/NCT01327625",
      "authors": "clinicaltrials.gov",
      "host": "clinicaltrials.gov",
      "snippet": "Intervention/treatment A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or m",
      "score": 0.44102347
    },
    {
      "number": 24,
      "title": "Tamibarotene for the Treatment of Bronchiolitis Obliterans ...",
      "detail": "journal.chestnet.org",
      "url": "https://journal.chestnet.org/article/S0012-3692(18)32340-7/fulltext",
      "authors": "journal.chestnet.org",
      "host": "journal.chestnet.org",
      "snippet": "by S Watanabe · 2019 · Cited by 6 — BO responds poorly to corticosteroids or immunosuppressants, and there are currently no established treatment approaches.",
      "score": 0.4250568
    }
  ],
  "publishedAt": "2026-08-21T01:33:35.155713+00:00",
  "updatedAt": "2026-08-21T01:33:35.155713+00:00",
  "readingMinutes": 5,
  "slug": "bronchiolitis-obliterans"
}