Addition of low dose azithromycin (250 mg 3x/week).Sequelae of BOS include progressive dyspnea, impaired gas exchange, and bronchiectasis with recurrent infections. Other factors promoting BOS include previous acute rejection, CMV infection, pneumonias and gastroesophageal reflux. However a steroid bolus may be tried if a component of acute rejection is suspected. The CT scan in BOS typically shows mosaic attenuation reflecting gas trapping, hyperinflated parenchyma, and areas of bronchiectasis.īOS is sometimes called "chronic rejection" but it is not strictly an immunologic phenomenon and does not typically respond to a steroid bolus. BOS 0p FEV1 81-90% of baseline or FEF 25-75 BOS 0 FEV1 of baseline and FEF 25-75 > 75% of baseline.This baseline is the average of the two best FEV1 results post transplant obtained at least three weeks apart. It is uncommon in the first two years after lung transplant, but it eventually affects the majority of lung transplant recipients and is the leading cause of death beond the first year post transplant.īecause Bronchiolitis Obliterans is not readily demonstrated on transbronchial biospies, the term Bronchiolitis Obliterans Syndrome is applied to lung transplant recipients who demonstrate a sustained and presumed permanent drop in lung function that does not have another apparent cause (such as airway stenosis, infection, pulmonary edema or effusions)īOS is defined as a 20% drop in FEV1 from the post transplant baseline.
Chronic Lung Allograft Dysfunction (CLAD)īronchiolits Obliterans refers to the permanent loss of lung allograft function due to airway remodeling and fibrosis.
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