Efficacy of Whole-Lung Lavage in Treatment of Pulmonary Alveolar Proteinosis

Abstract

The aim of the study was to investigate the therapeutic effect of whole-lung lavage (WLL) for pulmonary alveolar proteinosis (PAP). The cohort studies that investigated the therapeutic effect of WLL for PAP were selected strictly on the basis of the inclusion and exclusion criteria. The statistical analysis was performed using STATA statistical software (version 12.0; Stata Corporation, College Station, TX). Twelve studies were included in this meta-analysis. Totally, 206 PAP patients who received WLL were recruited in the 12 studies. We compared the differences in blood gas analysis and lung function before and after the treatment in this meta-analysis. The results indicated that there were statistical differences in the levels of diffusing capacity for carbon monoxide, forced expiratory volume in 1 second, forced vital capacity, and arterial partial pressure of oxygen after the treatment of WLL for patients with PAP, whereas there were no evident differences in the levels of arterial partial pressure of carbon dioxide and arterial oxygen saturation. In conclusion, WLL can evidently improve the diffusing capacity for carbon monoxide, forced expiratory volume in 1 second, forced vital capacity, and arterial partial pressure of oxygen of patients with PAP, thus WLL may be an important treatment of PAP.

Nebulised sargramostim in pulmonary alveolar proteinosis

“…Currently, the mainstay of management in Australia has been for planned admission to intensive care for WLL. [10][11][12][13][14] In the absence of evidence for treatment superiority of WLL to GM-CSF, patients and their health care providers may favour non-invasive options as an initial treatment. 24 Nebulised GM-CSF provides one of the first simple pharmacotherapeutic alternatives in the management of these patients.…”

“…Pulmonary alveolar proteinosis has the potential to be a chronic and debilitating condition in those patients where spontaneous remission fails to occur. Currently, the mainstay of management in Australia has been for planned admission to intensive care for WLL 10–14 . In the absence of evidence for treatment superiority of WLL to GM‐CSF, patients and their health care providers may favour non‐invasive options as an initial treatment 24 .…”

“…Traditional treatment has been largely restricted to whole lung lavage (WLL) 10–14 . WLL was developed as a means of overcoming perfusion‐ventilation mismatch by physically removing or washing lipo‐proteinaceous material from the distal airways leading to symptomatic stability and remission for some.…”

“…Disease persistence and ongoing surfactant accumulation may therefore necessitate repeated treatments 15 . Whole lung lavage has been shown to provide symptomatic, radiographic and functional improvements 10–14 …”

Autoimmune pulmonary alveolar proteinosis successfully treated with lung lavage in an adolescent patient: a case report

“…Asymptomatic patients may be closely observed and monitored without specific treatment [ 37 ]. For symptomatic patients, WLL is the most effective form of treatment and, for a long time, considered the “standard of care” [ 45 , 46 ]. Data suggest that the introduction of the WLL to the treatment plan of PAP significantly improved 5-year survival [ 45 ].…”