From the Guidelines
Treatment for Bronchiolitis Obliterans (Constrictive Bronchiolitis)
The primary treatment for bronchiolitis obliterans involves managing symptoms and slowing disease progression, typically with immunosuppressive medications.
- Azithromycin is often prescribed at a dose of 250 mg, three times a week, due to its anti-inflammatory properties 1.
- Inhaled corticosteroids such as fluticasone may also be used to reduce inflammation.
- In more severe cases, oral corticosteroids like prednisone may be necessary, with a gradual tapering of the dose 1.
- Macrolide antibiotics such as azithromycin may be continued long-term to help control symptoms 1.
- Lung transplantation may be considered in advanced cases where other treatments have failed and the disease has significantly impacted lung function 1. It's essential to work closely with a healthcare provider to determine the best course of treatment and monitor the disease's progression. For lung transplant recipients who develop a decline in FEV1 consistent with the onset of BOS, a trial of azithromycin is suggested 1. Additionally, switching from cyclosporine to tacrolimus may be considered to mitigate lung function decline 1. In cases of confirmed gastro-oesophageal reflux, referral to an experienced surgeon for potential fundoplication of the gastro-oesophageal junction may be suggested 1. Ultimately, the treatment approach should be individualized based on the patient's specific needs and disease severity.
From the Research
Treatment Options for Bronchiolitis Obliterans
The treatment for Bronchiolitis Obliterans (Constrictive Bronchiolitis) is primarily based on symptomatic therapy, with the use of corticosteroids being controversial but common 2. Some studies suggest that patients with Bronchiolitis Obliterans Organizing Pneumonia (BOOP) may respond well to corticosteroids, with a remarkable response in some cases 2.
Alternative Treatment Approaches
Other treatment approaches that have been explored include:
- Tamibarotene, a novel synthetic retinobenzoic acid, which has shown promise in treating Bronchiolitis Obliterans associated with chronic graft-vs-host disease 3
- Fluticasone-azithromycin-montelukast (FAM) combination, etanercept, extra-corporeal photopheresis (ECP), and lung transplantation, which have been used to treat Bronchiolitis Obliterans Syndrome (BOS) 4
- Intensification of immune suppression, which has been used to treat established disease, although with limited benefit 5
Challenges in Treatment
The treatment of Bronchiolitis Obliterans can be challenging, with limited availability of effective treatments and diagnostic tools in some parts of the world 4. Additionally, the disease can be severe and potentially devastating, with a high mortality rate 5, 6.
Key Considerations
Key considerations in the treatment of Bronchiolitis Obliterans include: