We present four cases of patients admitted to an acute geriatric unit with a presumptive diagnosis of bronchiolitis obliterans organizing pneumonia between 2001 and 2005. Because of the difficulty of performing transbronchial biopsy in these patients, who showed a variety of clinical presentations, the suspected diagnosis was based on clinical and radiological findings and a favorable response to empirical corticosteroid treatment. The clinical and radiological features of this entity in the elderly, as well as the therapeutic options, are reviewed.