Response to WLL

Most people diagnosed with pulmonary alveolar proteinosis (PAP) experience an effect after treatment with whole lung lavage (WLL). Some may enter a long period of ‘remission’ after treatment with WLL. Remission means that you feel much better, experience fewer symptoms and that you are able to go back to your normal activity level.

The purpose of WLL is to improve the function of the lungs. If you respond well to the treatment it will improve your blood oxygen content and you will experience fewer episodes of breathlessness or coughing. You may also be less likely to develop chest infections.

Though the majority respond well to the treatment some people with PAP may need to have WLL over a longer period of time in order to feel better. In some very severe cases, several treatments by WLL are needed just to control the PAP and prevent it from getting worse.

What are the risks of whole lung lavage?

The risk of whole lung lavage is primarily associated with the risk of general anaesthesia including:

• Damage to the teeth and gums and sore throat from the placement of the large breathing tube – this is identical to risks in all other procedures that need general anaesthesia.
• Possible allergic reactions to the drugs used during anaesthesia.
• There is a potential risk that the blood oxygen level will fall during the treatment because while the treated lung is washed, only one lung can be used for breathing.

People with PAP who are more prone to infections have a small risk of the infection being made worse by WLL treatment.

Doctors’ experience

According to doctors whole lung lavage (WLL) is a safe and efficient way of treating pulmonary alveolar proteinosis (PAP). Though it is now possible to wash both lungs at the same time, doctors in e.g. the UK and Denmark recommend that only one lung is washed, as this eases the patient’s recovery.

Danish and English doctors wash one lung with 15-30 l of saline, depending on how sick the patient is. Then the patient gets a lung massage and the procedure is repeated until the fluid is clear.

In the UK, whole lung lavage is used as standard therapy. Here patients spend 5 hours in the operating theatre and 5 hours in recovery. According to doctors, it is a relatively gentle ride compared to other theatre operations, and it leaves the patients feeling physiologically and clinically better.

In doctors’ experience patients respond to WLL in two ways: they can either be permanently better or, after initial improvement, they will experience an unpredictable cycle of gradual deterioration. This state may require that the procedure is repeated once, twice, or several times. So far, doctors have no way of predicting how often or how many lung lavages will be required.