{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:41:44Z","timestamp":1792215704019,"version":"4.4.0"},"reference-count":41,"publisher":"European Respiratory Society (ERS)","issue":"170","license":[{"start":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T00:00:00Z","timestamp":1700611200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2023,8,29]]},"published-print":{"date-parts":[[2023,12,31]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p>Autoimmune pulmonary alveolar proteinosis (aPAP) results from impaired macrophage-mediated clearance of alveolar surfactant lipoproteins. Whole lung lavage has been the first-line treatment but recent reports suggest the efficacy of granulocyte\u2013macrophage colony-stimulating factor (GM-CSF). We aimed to review the efficacy and safety of nebulised GM-CSF in aPAP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>We conducted a systematic review and meta-analysis searching Embase, CINAHL, MEDLINE and Cochrane Collaborative databases (1946\u20131 April 2022). Studies included patients aged &gt;18\u2005years with aPAP receiving nebulised GM-CSF treatment and a comparator cohort. Exclusion criteria included secondary or congenital pulmonary alveolar proteinosis, GM\u2013CSF allergy, active infection or other serious medical conditions. The protocol was prospectively registered with PROSPERO (CRD42021231328). Outcomes assessed were St George's Respiratory Questionnaire (SGRQ), 6-min walk test (6MWT), gas exchange (diffusing capacity of the lung for carbon monoxide (<jats:italic>D<\/jats:italic><jats:sub>LCO<\/jats:sub>) % predicted) and arterial\u2013alveolar oxygen gradient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Six studies were identified for review and three for meta-analysis, revealing that SGRQ score (mean difference \u22128.09, 95% CI \u221211.88\u2013\u2005\u22124.3, p&lt;0.0001), functional capacity (6MWT) (mean difference 21.72\u2005m, 95% CI \u22122.76\u201346.19\u2005m, p=0.08), gas diffusion (<jats:italic>D<\/jats:italic><jats:sub>LCO<\/jats:sub>% predicted) (mean difference 5.09%, 95% CI 2.05\u20138.13%, p=0.001) and arterial\u2013alveolar oxygen gradient (mean difference \u22124.36\u2005mmHg, 95% CI \u22127.19\u2013\u2005\u22121.52\u2005mmHg, p=0.003) all significantly improved in GM-CSF-treated patients with minor statistical heterogeneity (I<jats:sup>2<\/jats:sup>=0%). No serious trial-related adverse events were reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>Patients with aPAP treated with inhaled GM-CSF demonstrated significant improvements in symptoms, dyspnoea scores, lung function, gas exchange and radiology indices after treatment with nebulised GM-CSF of varying duration. There is an important need to review comparative effectiveness and patient choice in key clinical outcomes between the current standard of care, whole lung lavage, with the noninvasive treatment of nebulised GM-CSF in aPAP.<\/jats:p><\/jats:sec>","DOI":"10.1183\/16000617.0080-2023","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T10:17:53Z","timestamp":1700648273000},"page":"230080","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":25,"title":["Nebulised granulocyte\u2013macrophage colony-stimulating factor (GM-CSF) in autoimmune pulmonary alveolar proteinosis: a systematic review and 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