If there are minimal symptoms or no progression, no treatment is necessary. The individuals and chest x-rays can be followed closely until the BOOP disappears.

Most of the time, medication is needed. Since BOOP is inflammation of the lungs, the most appropriate treatment is an anti-inflammation medication. Corticosteroid medication is the current best treatment. This may be given intravenously while in the hospital or given as tablets in the form of prednisone.

The starting dose of prednisone is usually high, often 60 mg per day for several days or a few weeks. This amount is decreased to 40 mg per day for a few weeks to three months. The dosage is then gradually decreased over a period of one year. Sometimes, prednisone can be given on an every other day dosage, which will decrease the adverse effects. Sometimes the prednisone can be given for a 6-month duration, occasionally even shorter.

BOOP may recur in up to one-third of individuals. Fortunately, the BOOP will respond a second, third time and more to the same dosage as previous. Eventually, over time, the BOOP will almost always resolve or will at least stabilize.

Side effects and adverse reactions of prednisone. Side effects of prednisone can be numerous. Most are reversible, but some are not. This medication can save a person's life, but can also cause difficulties in some individuals.

The common side effects include increased appetite, weight gain, and bruising of the skin. A rounded puffy face, acne-like skin lesions, and "fat pads" below the neck in the front and back may also develop over time.

Psychological effects, high blood pressure, diabetes, and osteoporosis (softening of the bones) may develop. Cataracts can occur. A very rare condition known as aseptic necrosis of the hips requiring hip replacement may develop.

Some individuals have no difficulty with prednisone. Others may be bothered by some of adverse reactions but can tolerate them. Sometimes, a person cannot take the medication or develops a severe adverse reaction.

The prednisone is given at the lowest dose that is effective for the shortness length of time as possible. An every other day dosage can decrease the side effects.

Failure to Respond to Prednisone

There are several reasons that individuals don't respond to treatment. First, the BOOP may be resistant to prednisone treatment. Second, individuals may lack steroid receptors to activate the prednisone. Third, a common reason for treatment failure is that the BOOP is secondary to an underlying primary lung disease such as idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP), which is a fibrotic (scar-forming) disease and not an inflammatory (BOOP) disease. Detailed review of the lung biopsy or results of a high-resolution chest computer scan can be used to sort out these two diagnoses. IPF/UIP will have a biopsy that shows "fibroblastic foci" and a chest CT scan that will show "honeycombing" or cystic scarring. BOOP will not have the fibroblastic foci and will not have honeycombing by the chest CT scan.

In very rare situations, lung transplantation may be necessary for patients who do not respond to treatment or have an unusual or hybrid form of BOOP.

Outcome of BOOP

Total and permanent recovery is seen in 65 to 80 percent of individuals treated.

The mortality (death) rate remains at about five percent.

Less favorable signs include a rapidly progressive illness of a few days, a chest x-ray that shows small linear shadows at the