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Organizing pneumonia

Last reviewed: 5 Apr 2025
Last updated: 01 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • flu-like illness with low-grade fever, fatigue, and arthralgia
Full details

Other diagnostic factors

  • cough
  • shortness of breath
  • bilateral crackles
Full details

Risk factors

  • infectious pneumonia
  • connective tissue diseases
  • immunologic diseases and inflammatory bowel disease
  • organ transplantation
  • medication use
  • breast radiation therapy
  • exposure to toxins
  • vaping
Full details

Diagnostic tests

1st tests to order

  • chest x-ray
  • high-resolution chest CT scan (HRCT)
  • CBC
  • erythrocyte sedimentation rate
Full details

Tests to consider

  • CRP
  • sputum culture
  • atypical viral screen
  • pulmonary function tests
  • surgical lung biopsy
  • creatine kinase
  • general autoimmune and myositis profile
  • positron emission tomography (PET) scan
  • bronchoscopy
Full details

Treatment algorithm

INITIAL

rapidly progressive OP

ACUTE

cryptogenic OP

secondary OP

ONGOING

recurrent OP, rapidly progressive

recurrent OP, not rapidly progressive

Contributors

Authors

O'Neil Green, MBBS, FCCP

Assistant Professor in Medicine

Director, NTM and Bronchiectasis Clinic

UMass Chan School of Medicine/Baystate Health

Worcester

MA

Disclosures

OG has been a consultant to Pharming Inc. and has received research grants from Fisher & Paykel Inc. and Insmed Inc.

Jean-Pierre Assaker, MD

Pulmonary and Critical Care Fellow

UMass Chan School of Medicine/Baystate Health

Worcester

MA

Disclosures

JA declares that he has no competing interests.

Acknowledgements

Dr O’Neil Green and Dr Jean-Pierre Assaker would like to gratefully acknowledge Dr Gary R. Epler, the previous contributor to this topic.

Disclosures

GRE is an author of several references cited in this topic.

Peer reviewers

Nazia Chaudhuri, MbChB, BSc, PhD, FRCP

Clinical Lead of ILD Service

Manchester University NHS Foundation Trust

Manchester

UK

Disclosures

NC declares that she has no competing interests.

Steven Sahn, MD

Professor of Medicine and Director

Division of Pulmonary/Critical Care/Allergy/Sleep Medicine

Medical University of South Carolina

Charleston

SC

Disclosures

SS declares that he has no competing interests.

Teofilo Lee-Chiong, MD

National Jewish Medical and Research Center

Denver

CO

Disclosures

TLC has been reimbursed by the American College of Chest Physicians (ACCP), American Academy of Sleep Medicine, American Thoracic Society, and Cephalon, the manufacturer of modafinil, for attending several conferences. He has been paid by the ACCP for running educational programs and by Elsevier for serving as consultant of the Sleep Medicine Clinics. He has also received research funding from the National Institutes of Health, Respironics, Restore, and Schwarz Pharma, and has been a member of the speakers' bureau for GlaxoSmithKline.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Epler GR, Colby TV, McLoud TC, et al. Bronchiolitis obliterans organizing pneumonia. N Engl J Med. 1985 Jan 17;312(3):152-8. Abstract

Epler GR. Bronchiolitis obliterans organizing pneumonia, 25 years: a variety of causes, but what are the treatment options? Expert Rev Respir Med. 2011 Jun;5(3):353-61. Abstract

Bradley B, Branley HM, Egan JJ, et al; British Thoracic Society Interstitial Lung Disease Guideline Group, British Thoracic Society Standards of Care Committee; Thoracic Society of Australia; New Zealand Thoracic Society; Irish Thoracic Society. Interstitial lung disease guideline. Thorax. 2008 Sep;63 Suppl 5:v1-58.Full text  Abstract

Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013 Sep 15;188(6):733-48.Full text  Abstract

Lazor R, Vandevenne A, Pelletier A, et al. Cryptogenic organizing pneumonia: characteristics of relapses in a series of 48 patients. Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):571-7.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • Guidelines

    • ACR appropriateness criteria: chronic dyspnea-noncardiovascular origin
    • An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias
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  • Patient information

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  • Videos

    Late inspiratory crackles (rales)

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