From the Guidelines
Bronchiolitis obliterans treatment should focus on slowing disease progression and managing symptoms, with the primary approach including macrolide antibiotics, such as azithromycin (250-500 mg three times weekly), due to their anti-inflammatory properties, as supported by the most recent and highest quality study 1. The treatment of bronchiolitis obliterans (BO) is crucial in managing symptoms and slowing disease progression.
- The use of macrolide antibiotics, particularly azithromycin, has shown promise in improving lung function and quality of life in patients with BO, as demonstrated in a study where all patients showed improvement in FEV1 and all but one in FVC following treatment with azithromycin for 12 weeks 1.
- The FAM regimen, which includes fluticasone, azithromycin, and montelukast, has also been shown to be effective in maintaining lung function in patients with BO, with a study suggesting equivalent efficacy in maintaining lung function compared to historical controls treated with higher doses of systemic steroids 1.
- In terms of immunosuppression, switching from cyclosporine to tacrolimus may be beneficial for patients with BO, as suggested by a conditional recommendation with very low quality of evidence 1.
- For patients with confirmed gastro-oesophageal reflux (GOR), referral to an experienced surgeon for potential fundoplication of the gastro-oesophageal junction may be considered, as suggested by a conditional recommendation with very low quality of evidence 1.
- Ultimately, the treatment approach should be tailored to the underlying cause of BO, whether it's post-transplant, toxin exposure, or autoimmune-related, and early intervention is crucial in preventing further damage and improving quality of life.
- The use of corticosteroids, such as prednisone, is not recommended for patients with a decline in FEV1 consistent with BO, due to the lack of proven benefit and potential for serious adverse effects, as suggested by a conditional recommendation with very low quality of evidence 1.
From the Research
Treatment Options for Bronchiolitis Obliterans (BO)
The treatment for Bronchiolitis Obliterans (BO) varies depending on the specific type and cause of the disease. Some of the treatment options include:
- Corticosteroids: Corticosteroids are widely used for the treatment of BO, particularly for bronchiolitis obliterans organizing pneumonia (BOOP) 2, 3, 4, 5.
- Inhaled bronchodilators and corticosteroids: Although not recommended as maintenance therapy options for post-infectious bronchiolitis obliterans (PIBO), a case study showed improvement in airway obstruction with the use of inhaled corticosteroid/long-acting β2 agonist combination and inhaled long-acting antimuscarinic 6.
- Low-dose methotrexate: Low-dose methotrexate has been used to achieve complete remission of BOOP in a patient with Hodgkin's disease 2.
- Low-dose/long-term erythromycin: Erythromycin has been used as an alternative to corticosteroids for the treatment of BOOP, with good clinical, radiological, and physiological improvement 3.
- Cyclosporin: Cyclosporin has been used in combination with corticosteroids to treat refractory BOOP, allowing for a decrease in corticosteroid dosage 4.
- Pulmonary rehabilitation: A 3-week pulmonary rehabilitation program has been shown to improve physical performance in a patient with PIBO 6.
Treatment Outcomes
The outcome of patients suffering from BOOP is generally good, with up to 80% of individuals being cured with corticosteroid therapy 5. However, relapse can occur when corticosteroid dosage is tapered off, and alternative treatments such as low-dose methotrexate or cyclosporin may be necessary 2, 4.