Targeted Therapy of Bronchiolitis Obliterans Syndrome

Inclusion Criteria: * Diagnosis of BOS after HCT within the 6 months before study enrollment; for this study, BOS is defined as: * Forced expiratory volume in 1 second (FEV1) \< 75% of the predicted normal and FEV1 to slow or inspiratory vital capacity ratio (FEV1/SVC or FEV1/IVC) =\< 0.7, both measured before and after administration of bronchodilator OR * Pathologic diagnosis of BOS demonstrated by lung biopsy * The baseline absolute FEV1 must be \>= 10% lower than the pre-transplant absolute FEV1 as defined by the pre-transplant FEV1 minus the baseline FEV1, both measured before administration of a bronchodilator * Participant (or parent/guardian) has the ability to understand and willingness to sign a written consent document Exclusion Criteria: * Recurrent or progressive malignancy requiring anticancer treatment * Known history of allergy to or intolerance of montelukast, zafirlukast, azithromycin, erythromycin, or clarithromycin * Pregnancy or nursing; all females of childbearing potential must have a negative serum or urine pregnancy test \< 7 days before study drug administration * Transaminases \> 5 X upper limit of normal (ULN) * Total bilirubin \> 3 X ULN * Chronic treatment with any inhaled steroid for \> 1 month in the past three months * Treatment with montelukast or zafirlukast for \> 1 month during the past three months * Treatment with prednisone at \> 1.2 mg/kg/day (or equivalent steroid) * Treatment with rifampin or phenobarbital, aspirin at doses \> 325 mg/day, or ibuprofen at doses \> 1200 mg/day * Treatment with any Food and Drug Administration (FDA) non approved study medication within the past 4 weeks; off-label treatment with an FDA-approved medication is allowed * Chronic oxygen therapy * Evidence of any viral, bacterial or fungal infection involving the lung and not responding to appropriate treatment * Clinical asthma (variable and recurring symptoms of airflow obstruction and bronchial hyper-responsiveness) * Any condition that, in the opinion of the enrolling investigator, would interfere with the subject's ability to comply with the study requirements * Uncontrolled substance abuse or psychiatric disorder * Inability to perform pulmonary function tests (PFT) reliably, as determined by the enrolling investigator or PFT lab * Life expectancy \< 6 months at the time of enrollment as judged by the enrolling investigator * Baseline post-bronchodilator FEV1 \< 20% of predicted normal before or after albuterol