Prevention
Inhalants
Disease caused by exposure to industrial inhalants and burn pits can be prevented with the use of engineering controls (e.g., exhaust hoods or closed systems), personal protective equipment, monitoring of potentially affected personnel, worker education and training. Transplant
The primary prevention of bronchiolitis obliterans in people who have received either lung transplant or HSCT therapy is immunosuppression. In regards to post lung transplantation, the combination of calcineurin inhibitor combined with a purine synthesis inhibitor and a glucocorticoid is the general regimen used. People also have a baseline post-transplant lung function testing done in order to determine if their lung function is declining over time. People who are post-HSCT their immunosuppressive regimen typically includes methotrexate in combination with a calcineurin inhibitor to prevent GVHD, a risk factor for developing bronchiolitis obliterans. Treatment
While the disease is not reversible, treatments can slow further worsening. This may include the use of corticosteroids or immunosuppressive medication which may have an effect on the ability to receive a lung transplant if offered. If patients have difficulty breathing (hypoxemia) oxygen can be supplemented. Routine vaccinations are recommended for patients with chronic lung disease to prevent complications from secondary infections due to pneumonia and influenza.Transplant recipients are at risk for re-developing the disease, as bronchiolitis obliterans is a form of chronic rejection. Evaluation of interventions for its prevention relies on early detection of abnormal spirometry results or unusual decreases in repeated measurements.
A common finding on HRCT is patchy areas of decreased lung density, signifying reduced vascular caliber and air trapping. This pattern is often described as a "mosaic pattern", and may indicate bronchiolitis obliterans. Lung biopsy
Transthoracic lung biopsies are preferable for diagnosis of constrictive BO compared to transbronchial biopsies; regardless of the type of biopsy, a diagnosis may only be achieved by examination of multiple samples. Transthoracic biopsies are preferred over transbronchial due to the heterogeneity and distribution of the lesions. OB can be further classified into two categories: constrictive or proliferative. The constrictive pattern is demonstrated by peribronchiolar cellular infiltrates which eventually causes small airway damage and leads to subepithelial fibrosis. The bronchial muscle can eventually become fibrosed which can be identified with trichrome staining. In regards to proliferative disease, intraluminal buds called "Masson bodies" fill the lumen, which results in bronchiolar plugging. Often people with proliferative disease will show butterfly wing-like appearance under microscopy. One key determinate that can be seen on biopsy to differentiate constrictive from proliferative disease is the extent of lesions. Both lesions are localized from the small bronchi to the membranous bronchi, but in constrictive disease, the lesions are intermittent while proliferative disease has a continuous distribution. Differential diagnosis
Other conditions that can present similarly include chronic obstructive pulmonary disease, asthma, bronchiectasis, hypersensitivity pneumonitis, and pneumonia.