Bronchiolitis Obliterans: Next-Line Management When Azithromycin Fails to Improve Lung Function

In bronchiolitis obliterans, a structured macrolide trial is an established first step. When it does not produce the required degree of functional recovery, a defined escalation pathway determines what comes next.

Previous treatment — failure condition

A trial of azithromycin (oral), continued for a minimum of 3 months, did not meet the required threshold: an increase in FEV1 of at least 10%. Non-achievement of this goal triggers escalation to the next line of management.

Next-line approach (partial view)

When azithromycin has failed to restore lung function to the required degree, the protocol calls for a specialised surgical evaluation. The full protocol details the specific referral criteria and the complete evaluation pathway.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1183/09031936.00107514

For lung transplant recipients who have developed end-stage BOS refractory to other therapies, we suggest referral to a transplant surgeon to be evaluated for re-transplantation (conditional recommendation, very low quality evidence).

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