Pulmonary alveolar proteinosis is a rare illness characterized by alterations in the normal depuration of surfactants from the alveolar space in a process dependent of the granulocyte-monocyte colony stimulating factor (GM-CSF). The most of the patients develop antibodies that neutralize this factor, avoiding the normal homeostasis of surfactants. Therapeutic options include the total lung washes and administration of GM-CSF when the washes fail. Despite the contribution related with the knowledge about of the nature of the disease, the measurement of serum antibodies anti-GM-CSF is not a routine technique. We present a systematic review of this challenging disease.