known to cause it when aspirated. The ingestion of large doses of papaverine in the vegetable Sauropus androgynus has caused it. Additionally, the disorder may be idiopathic (without known cause). Lung transplant Bronchiolitis obliterans is a common complication in lung transplants because transplanted lungs are at greater risk of alloimmunization as compared to healthy lungs. The disease is often termed bronchiolitis obliterans syndrome (BOS) in the setting of post lung transplantation and hematopoietic stem cell transplant (HSCT). Patients who develop BOS post lung transplant vary in disease latency and severity. Patients often initially have normal lung function on pulmonary function testing and have normal chest radiographs. As the disease progresses they begin to have symptoms of shortness of breath, cough, and wheezing as their lung function declines. The Journal of Heart and Lung Transplantation published updated guidelines in 2001 for grading the severity of BOS. The original guidelines and classification system were published in 1993 by the International Society for Heart and Lung Transplantation. Their scoring system is based on the changes in FEV1 in patients from their baseline. When patients are first diagnosed with BOS they have their baseline lung function established by doing pulmonary function testing at the time of diagnosis. The BOS scoring system is as follows: BOS 0: FEV1 > 90% of baseline and FEF25-75 > 75% of baseline BOS 0-p: FEV1 81-89% of baseline and/or FEF25-75 <= 75% of baseline BOS 1: FEV1 66-80% of baseline BOS 2: FEV1 51-65% of baseline BOS 3: FEV1 50% or less of baseline The scoring system shows an increased severity of the disease as the BOS number increases. Hematopoietic stem cell transplant Bronchiolitis obliterans affects up to 5.5% of people who have received HSCT. One of the biggest risk factors after HSCT is the development of GVHD with a 14% risk. Other risk factors post transplant including tobacco use, age of donor, age of recipient, lower baseline FEV1/FVC ratio, non-caucasian race, peripheral and lower circulating IgG levels. Studies have, however, shown mixed results regarding these other risk factors. There has been an association shown between the increased use of peripheral stem cells and the risk of developing bronchiolitis obliterans. Also, research has shown an increased risk for developing the disease within the first year of transplant if the person is infected with respiratory syncytial virus or parainfluenza virus within the first 100 days post transplant. Inhalants There are