I've had about 12 lavages. My first set was done in January 2015. I had a little over a year’s remission before the PAP came back with a vengeance. After each lavage my remission varies. Sometimes I get three weeks. Other times I've gotten about 12 weeks. I started inhaled GM-CSF in February 2017 250MCG once a day. After reading some of the post on here I asked my doctor to increase me to twice a day about two weeks ago. I had a another whole lung lavage November 9th 2017. They can normally do both my lungs in one sitting. This time was pretty rough. Some how my lung was punctured during the procedure. I normally go home the same day. I ended up with a chest tube and staying through the weekend. Over the summer the doctors added IV infusions of rituximab and plasma apheresis. Both things helped, but it just wasn't enough to get the PAP under control. Tomorrow I go back down to Baltimore and they are adding Cybor-D to my treatment. My PAP seems to be pretty aggressive and the doctors are worried about potential scarring. I had to stop working a year ago and now I am on disability. For those of you using GM-CSF twice a day how fast did you notice it working? How do you manage the constant coughing? I can’t even lay down to sleep. Everything makes me cough or feel short of breath. What are your triggers and what changes have you made to avoid them? I feel like i'm fighting a losing battle.