For those with a rare lung disease, this procedure clears the air

“I feel like the elephant is off my chest.”

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Those are the words anesthesiologist Basem Abdelmalak, MD, hopes to hear from a patient after a lung lavage procedure. Commonly called “lung washing,” this procedure treats the rare lung disease pulmonary alveolar proteinosis (PAP).

For patients with PAP, a substance called surfactant builds up in their lungs over time. The more surfactant, the harder it becomes to breathe. PAP leaves many otherwise healthy people relying on oxygen.

That’s when lung lavage helps. After this procedure, many are able to get back to work and everyday activities without the need for oxygen.

Pulmonologist Daniel Culver, DO, says one patient jokingly asked if the doctor could power-wash his lungs. “I had been deciding whether lung lavage was an option for this patient. When he asked that, I said, ‘Well, actually, we can.’ ”

How lung washing works

Lung lavage has been around for a number of decades, but the latest advance is treating both lungs at once to save patients time and stress, Dr. Abdelmalak says. Doing so takes special care and monitoring. It’s a step-by-step process:

Start with the most diseased lung. The anesthesia team separates the lungs using a device called a double lumen breathing tube. Basically, they ask the healthier lung to breathe for the whole body while they clean the sicker one. Use gravity. Using special tubing, the team flushes saline solution through the lung with the help of gravity. They circulate around 10–20 liters of fluid through each lung on average — but severe cases may require up to 50 liters. The liquid starts out very dark but becomes clearer as the process continues. Add shaking and suction. Doctors wrap a vest around the patient’s chest. This vest shakes the body to help agitate the abnormal protein, mix it up with the washing liquid and help remove it. Afterward, the team uses suction devices to remove liquid that gravity and shaking left behind. Test and switch. After a break, the team attempts to repeat the process for the other lung. But first, they must test and make sure the newly cleaned lung is functioning well enough to breathe for the body.

After the procedure, patients may need a bit more oxygen than usual for the first couple of days as the lungs finish the cleaning process on their own. But most patients start to feel the benefit within a few days, Dr. Abdelmalak says.

“It can be a tremendous relief for them,” he says. “Outcomes will vary, but in the best cases, it helps people return to an active, healthy life.”

Not for other lung diseases

Pulmonologist Jihane Faress, MD, notes that lung lavage does not work for other lung conditions.

“Patients ask about COPD or lung fibrosis because they want to help their loved ones, but this really is for PAP,” she says. “It works well because of the nature of the disease, but it could actually cause challenges with these other conditions.”

However, along with newer medication options, lung lavage has radically changed the outlook for patients with PAP.

“Before lung lavage was established, the mortality rate for PAP was 90 percent,” Dr. Culver says, “but people rarely die of the disease now. Whole lung lavage really revolutionized the way we treat it, and the way people live with it.”