Trypsin aerosol treatment of pulmonary alveolar proteinosis. Case report

A patient with pulmonary alveolar proteinosis was given 3 month courses of aerosolized trypsin in doses of 100,000 units twice daily. The treatment was well tolerated, with minimal side effects, permitting continuation of therapy at home. After prolonged periods of observation, during which there was progression of disease, the patient experienced dramatic clinical, radiographic, and functional improvement with therapy, which suggested that therapy was causally related to remission. It is suggested that aerosolized trypsin, initiated in the hospital, is the preferred treatment for pulmonary alveolar proteinosis of moderate severity and for mild but progressive disease.