title: Efficacy of Whole-Lung Lavage in Pulmonary Alveolar Proteinosis: A Multicenter International Study of GELF.
abstract: BACKGROUND
  New therapies have emerged in the treatment of pulmonary alveolar proteinosis (PAP) and, therefore, there is a real need to evaluate the efficacy of whole-lung lavage (WLL) in this rare disease.
  
  
  OBJECTIVE
  The aim of this study was to assess the efficacy of WLL in patients with PAP.
  
  
  METHODS
  We included 33 patients from 12 centers, which are members of the French-Speaking Thoracic Endoscopy Group, for analysis. Data collection concerned patients and disease characteristics, pulmonary function tests (PFTs) and technical information on the procedure.
  
  
  RESULTS
  The median age of the patients was 44 years (range 13-77). There were 23 (71.9%) patients with respiratory insufficiency at presentation. All patients underwent WLL by general anesthesia and selective lung ventilation, except 1 who underwent awake flexible bronchoscopy. We noted differences in the technique, as 12 (36.36%) patients had percussion during the procedure and only 4 (12.1%) patients underwent 2-lung lavage during 1 anesthesia. A median of 12 L was used to perform WLL (1.0-40 L). Complications occurred in 11 (33.3%) patients, and 18 (56.25%) of them relapsed in a median period of 16.9 months. No significant changes were found in any PFT parameters studied, except for PaO2, which was significantly improved by 6.375 mm Hg (p = 0.0213) after the procedure compared to before.
  
  
  CONCLUSIONS
  Although the application of the WLL technique was variable, overall, it significantly improved patients' short-term respiratory condition by improving PaO2. However, a long-term effect needs to be confirmed, as many of our patients relapsed.
authors.affiliation: Department of Pulmonology, University Hospital of Saint-Étienne, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Gay
authors.forename: Benoit
authors.initials: B
authors.lastname: Wallaert
authors.forename: Stefan
authors.initials: S
authors.lastname: Nowak
authors.forename: Jonas
authors.initials: J
authors.lastname: Yserbyt
authors.forename: Stavros
authors.initials: S
authors.lastname: Anevlavis
authors.forename: Christophe
authors.initials: C
authors.lastname: Hermant
authors.forename: Alban
authors.initials: A
authors.lastname: Lovis
authors.forename: Olivier
authors.initials: O
authors.lastname: Menard
authors.forename: Bernard
authors.initials: B
authors.lastname: Maitre
authors.forename: Thomas
authors.initials: T
authors.lastname: Vandemoortele
authors.forename: Hervé
authors.initials: H
authors.lastname: Dutau
authors.forename: Amandine
authors.initials: A
authors.lastname: Briault
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourdin
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Vergnon
authors.forename: Marios E
authors.initials: ME
authors.lastname: Froudarakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011649:Pulmonary Alveolar Proteinosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult