Bronchiolitis obliterans
ICD-10 J44.8 · ICD-11 CA26.Y

Treatment of Bronchiolitis Obliterans in Lung Transplant Recipients with Declining FEV1

Clinical scenario

Lung transplant recipients who develop a decline in FEV1 consistent with the onset of bronchiolitis obliterans syndrome (BOS) require a specific, evidence-guided first-line treatment approach.

First-line approach

The recommended initial intervention involves a structured macrolide antibiotic trial carried out over a defined minimum duration — the full protocol, schedule, and criteria are available in the complete structured regimen.

Treatment goal

Measurable improvement in lung function — specifically an increase in FEV1 of at least 10% — assessed at completion of the treatment trial.

Instant Access to Structured Evidence-Based Regimens

References

  1. For lung transplant recipients who develop a decline in FEV1 consistent with the onset of BOS, we suggest a trial of azithromycin (conditional recommendation, very low quality evidence).
  2. Azithromycin is generally administered orally at 250 mg per day for 5 days and then 250 mg three times per week.
  3. We define a trial of azithromycin as treating continuously with azithromycin for a minimum of 3 months.
  4. The studies found that 30–83% of patients had improved lung function (defined as an increase in FEV1 of ≥10%) after receiving azithromycin, even though the mean FEV1 did not increase in some studies because nonresponders continued to have lung function decline.

DOI: 10.1183/09031936.00107514

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