CORRESPONDENCE

Call for an international survey on therapeutic lavage for pulmonary alveolar proteinosis To the Editors: Pulmonary alveolar proteinosis (PAP) is a syndrome char-acterised by accumulation of proteinaceous, periodic acid-Schiff positive material within airspaces due to disruption of surfactant homeostasis [1]. In 95 % of cases, PAP is associated with increased serum levels of auto-antibodies neutralising granulocyte-macrophage colony-stimulating factor and, there-fore, this form is referred to as ‘‘auto-immune PAP’ ’ [2]. Irrespective of the underlying cause, the current standard of care for PAP is represented by whole lung lavage (WLL) and, to a lesser extent, bronchoscopic lobar/segmental lavage [3]. WLL has played such a critical role in the management of patients affected by PAP, whose natural history had bee