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One friend of mine had problem with chronic rejection of the lung allograft. His doctor said it is defined as a fibrosing process affecting the lung, which primarily affected the conducting airways and the pulmonary vasculature. I found out the process affecting the conducting airways has been labeled bronchiolitis obliterans. I am so much worried about my friend now so I would like you to help me. Could you tell me more about bronchiolitis obliterans?

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The concept of bronchiolitis obliterans is a difficult one because the term has been utilized as both a morphologic descriptor and syndrome. Bronchiolitis obliterans describes an intraluminal polypoid plug of granulation tissue found within the terminal and respiratory bronchioles. This granulation tissue polyp is a very non-specific histologic finding as it is seen in most infectious pneumonias. It seems as diffuse alveolar damage, aspiration, usual interstitial pneumonia, cryptogenic organizing pneumonia, among other conditions. To the pulmonologist, bronchiolitis obliterans implies a chronic scarring process affecting the small airways of the lung. This is resulting in progressive obliteration of the small airways with resultant obstructive lung disease. In the setting of lung transplantation, we utilize the term bronchiolitis obliterans in a hybrid fashion. However, in the lung allograft, bronchiolitis obliterans represents dense irreversible eosinophilic scarring of the terminal and respiratory bronchioles. This either might partially or totally obliterate the lumen of the airway. By utilizing this definition, bronchiolitis obliterans is usually an irreversible process, and therefore has a strong correlation with diminished pulmonary function test scores.
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