Whole lung lavage in comparison with bronchoscopic lobar lavage using the rigid bronchoscope in patients with pulmonary alveolar proteinosis: Is it time to change strategy?

Background: Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of surfactant lipoproteins within the alveoli that leads to impaired oxygen transfer across the alveoli. Recent investigations showed that the most effective method of its treatment is the mechanical removal of surfactant material from the alveoli. Methods: 12 patients with PAP treated either with bronchoscopic lobar lavage (Group A, 5 patients) or whole lung lavage (Group B, 7 patients) from August 2006 till September 2016 were included. Results: The average lavage time was significantly shorter in Group B (2.5 ± 0.5 h) than Group A (4 ± 0.5 h). Also the average lavage volume was significantly bigger in group B (17 ± 1 L) than in group A (9 ± 1.5 L). The average hospital stay in group B was significantly longer (10 ± 2 d) than in group A (5 ± 2 d). All patients could be followed up in a mean period of 62.3 ± 21.2 months. In group A, 4 patients required relavage within 2 years of the initial lavage, while in group B one patient (14.25%) required relavage within 2 years and 2 patients (28.5%) within 3 years. These results were of statistically significant difference. Conclusion: Whole-lung lavage is more efficient than bronchoscopic lobar lavage in treating PAP as it provides larger lavage volumes in shorter time periods and is also associated with lower rate of recurrence of symptoms and the need of relavage