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Living with aPAP: Karli’s long road to diagnosis

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I was at the beach, and it took me thirty minutes to get from the hotel room down to the beach. And I couldn't walk the fifty feet to go from the pier to my beach chair, and I just knew something was wrong. Somebody’s got to be able to help me. The first thing I was diagnosed with was bronchitis and I was treated with the normal antibiotics and steroids for a couple of weeks and when I didn't get better, I went back and they thought maybe you have asthma. So, they treated me for asthma. I saw nine different kinds of specialists and I finally found my pulmonologist that did diagnose me with aPAP. When I first saw my pulmonologist and I told him what had been going on, I told him that I couldn't keep living like this, which is not something I had told any doctor before that, and he actually took me seriously. He sent me immediately that day in his office to have pulmonary function testing and he sent me for x-rays. And as soon as they came back, he came back in the room and he was like “I don’t know you walked in here from the parking lot”, because my lung function was 43% - which is crazy that I was just walking around like that. He was like “I don’t really know how you’re still standing but a lot of things make sense and we’re going to get to the bottom of it.” I found out that there was a blood test to confirm aPAP after I was already diagnosed. A quicker diagnosis would have meant that I didn't miss out on three years of my life. For people that are living with unresolved respiratory symptoms, I’d say don't give up on yourself and advocate for yourself. Lung disease gets dismissed as all kinds of things. For me it was dismissed as anxiety, GI issues. If things are not adding up just keep looking for an answer. When you can't breathe, nothing else matters.

What Are the Symptoms of PAP?

The symptoms of PAP can vary and may be non-specific. Many of the symptoms are similar to other lung diseases such as asthma or pneumonia. The most common symptom of PAP is shortness of breath, also called dyspnea. Other symptoms include:

  • Cough 
  • Cyanosis (bluish skin and fingernails)
  • Clubbing (changes in the nails on your fingers and/or toes)
  • Inspiratory crackles (popping sound heard when you inhale)

Symptoms that are less common include hemoptysis (coughing up blood), fever, chest pain, and fatigue. Approximately one third of patients may have no symptoms when first presenting with PAP.

When to See Your Healthcare Provider

Diagnosing PAP can be delayed because it is incredibly rare. It is important to see your healthcare provider when noticing unexplained shortness of breath which is the most common symptom of PAP. Alert your healthcare provider if you have any of the other symptoms associated with PAP.

How PAP Is Diagnosed

Your healthcare provider may order several tests to confirm if you have PAP. 

  • Chest X-ray/Chest CT: Imaging of your lungs may show opacities, or hazy areas, with a “crazy paving” pattern in your lungs that may indicate PAP.
  • Blood Testing: Can determine if you have aPAP, the most common form of PAP, by measuring the level of the GM-CSF antibodies in your blood. There is a free, simple GM-CSF autoantibody blood test available called aPAP ClearPathTM that can help confirm or rule out if you have aPAP. Your provider may get your blood sample through blood drawn from a vein or a finger prick. You can ask your healthcare provider about this test and learn more by contacting the Lung HelpLine.
  • Genetic Testing: Determines if you have hereditary, or genetic, PAP.
  • Bronchoscopy with Bronchoalveolar Lavage: A minimally invasive technique used to collect a sample of fluid from the lungs for testing; often considered the gold standard for diagnosis.
  • Lung Biopsy: Tissue from your lungs is removed for examination.
  • Pulmonary (Lung) Function Tests: Your healthcare provider may order a pulmonary function test to see how well your lungs are working.  This does not determine if you have PAP.
Graphic detailing that if you have symptoms that are similar to other lung conditions that are not responding to treatment and you have an abnormal CT scan, then you should suspect aPAP

Page last updated: June 5, 2025

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