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Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by abnormal accumulation of surfactant in the alveoli. Whole lung lavage (WLL) is the standard treatment for severe autoimmune PAP (aPAP); however, it is highly invasive. Intrapulmonary percussive ventilation (IPV) is a non‐invasive technique that delivers small bursts of high‐flow respiratory gas into the lung and mobilizes secretions. As IPV is beneficial for chronic respiratory diseases such as cystic fibrosis and bronchiectasis to reduce sputum, it was hypothesized that IPV will ameliorate aPAP by mobilizing and removing accumulated surfactant and foamy macrophages. Here, we report the case of a 52‐year‐old female with severe aPAP and progressive respiratory failure. She received intermittent IPV therapy for six months and thereby showed improvement in assessments of chest computed tomography (CT), lung function, and oxygenation. We suggest that IPV should be used as an alternative therapy for patients with aPAP and respiratory failure., We report the first case of severe autoimmune pulmonary alveolar proteinosis (aPAP) with progressive respiratory failure successfully treated by intrapulmonary percussive ventilation (IPV) therapy for six months.

We developed a training protocol based on Intrapulmonary Percussive Ventilation in order to prolong breath-hold while nearly suppressing the thorax motion. This protocol allowed ten subjects to achieve a 20-minutes-breath-hold, while reducing the residual surface motion to 1 mm around its mean position for more than 95% of the breath-hold duration.

Background: Chest physiotherapy has been used for many years to assist in the removal of abnormal viscid bronchial secretions in cystic fibrosis (CF) patients. Objectives:This study compared the short-term effects of two physiotherapy regimens in patients with CF: autogenic drainage (AD) preceded by either saline inhalation (‘salineNEB + AD’) or by intrapulmonary percussive ventilation (IPV) with saline (‘salineIPV + AD’). Methods: In a randomized crossover design, 20 clinically stable CF patients with similar pulmonary function at baseline received either ‘salineNEB + AD’ or ‘salineIPV + AD’ on 2 consecutive days. Transcutaneous oxygen saturation, heart rate, Borg dyspnea score and mucus wet weight were evaluated after 15 min of either salineNEB or salineIPV, and after a subsequent 30 min of AD. Results: There were no significant changes in oxygen saturation, heart rate or Borg score at any point of either physiotherapy intervention. There was no significant difference in sputum wet weight recovered with either salineNEB (2.2 ± 1.8 g, mean ± SD) or salineIPV (1.7 ± 1.9 g) alone. Subsequent AD did produce significantly greater amounts of sputum wet weight (p < 0.0001 for both) than in the initial saline delivery period, yet the amount of wet weight was similar irrespective of whether AD was preceded by salineNEB (9.7 ± 6.5 g) or salineIPV (11.6 ± 7.3 g). Conclusions: Recovered sputum weight is similar whether AD is preceded by salineNEB or salineIPV. The much greater amount of mucus obtained during the AD period than during the saline delivery period warrants further investigation.