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Whole lung lavage combined with Granulocyte-macrophage colony stimulating factor inhalation for an adult case of refractory pulmonary alveolar proteinosis

Hong yan Yu, Xue feng Sun, Yan xun Wang, Zuo jun Xu and Hui Huang*

Author Affiliations

Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, 100730 Beijing, China

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BMC Pulmonary Medicine 2014, 14:87  doi:10.1186/1471-2466-14-87

Published: 19 May 2014



Whole-lung lavage (WLL) is classically the first-line treatment for symptomatic pulmonary alveolar proteinosis (PAP). However, some patients require multiple WLLs because of refractory nature of their PAP. In this instance, these patients may benefit from new treatment regimens, and new therapies should be tried for these patients.

Case presentation

We describe a 47-year-old Chinese woman who was confidently diagnosed with pulmonary alveolar proteinosis (PAP) after bronchoalveolar lavage and transbronchial lung biopsy. The patient received four sessions of bilateral whole lung lavage (WLL) and one session of WLL in combination with plasmapheresis, each only producing short-term symptomatic relief. The patient was given a trial of combination therapy, which consisted of WLL and Granulocyte-macrophage colony-stimulating factor (GM-CSF) inhalation. The patient showed a gradual improvement in oxygenation and her daily activity, as well as a dramatic improvement in her pulmonary CT examination.


Bilateral WLL, in combination with GM-CSF inhalation, may be an effective treatment option for severe refractory PAP.

Refractory pulmonary alveolar proteinosis (PAP); GM-CSF inhalation; Plasmapheresis; Whole lung lavage (WLL); Combination therapy