Bronchiolitis obliterans is usually a late complication and is the main cause of long-term morbidity and mortality in lung transplant recipients. It presents clinically with progressive dyspnea, coughing, and wheezing. Pulmonary function tests deteriorate rapidly, with a decline in forced expiratory volumes and flow in a pattern similar to that observed with obstructive lung disease. Diagnosis is confirmed histologically with transbronchial biopsy. The etiology of bronchiolitis obliterans is not understood completely. Risk factors for its development seem to be recurrent and severe episodes of acute rejection and cytomegalovirus pneumonia. Once established, bronchiolitis obliterans is difficult to manage, short of retransplantation. The best approach is prevention and aggressive treatment of all episodes of rejection and infection. Surveillance is carried out with spirometric studies. Measurement of lung flows with home-based portable devices has also been found to be reliable.
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