Pulmonary Fibrosis Case Traced to ‘Bagpipe Lung’ in Musician


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bagpipe lung case study

Musicians who play wind instruments are being warned of a potential hazard doctors have dubbed “bagpipe lung” — after a case study was published of a man who died of a lung condition known as hypersensitivity pneumonitis, thought to have been caused by the mold and fungi that thrived in the moist interior of a set of bagpipes, which he repeatedly inhaled while playing.

Hypersensitivity pneumonitis is an inflammation of the alveoli within the lung, caused by hypersensitivity to inhaled organic dusts, fungus, molds or chemicals. Sufferers are commonly exposed to the triggers by their occupation or hobbies. The syndrome varies in intensity, clinical presentation, and natural history depending on its causing agent. In most cases, the disease can be treated and a patient’s prognosis is generally very good. But chronic inflammation can lead to pulmonary fibrosis, or irreversible lung scarring.

In the study “Bagpipe lung; a new type of interstitial lung disease?”, published in the journal Thorax, a team of clinicians described the case of a 61-year-old man referred to an interstitial lung disease (ILD) clinic in April 2014 with a seven-year history of dry cough and progressive breathlessness, despite immunosuppressive therapy. The condition had reduced  his exercise tolerance to 20 meters from over 10 kilometers.

The patient had been diagnosed in 2009 with hypersensitivity pneumonitis based on high-resolution CT (HRCT) and biopsy findings, but the cause had not been identified. He had never smoked, was not a pigeon fancier, and his home had no signs of  mold or water damage.

His symptoms were insidious and progressive, with the exception of a three-month period in 2011 when he went to live in Australia. He reported that during this time, his symptoms rapidly improved and that he was able to walk 10 kilometers on the beach without stopping. After returning to the U.K., however, his breathing deteriorated rapidly.

As a hobby, he played the bagpipes daily. He did not take his bagpipes to Australia.

This habit prompted the clinicians to test several areas inside the bagpipes. The samples taken grew various different fungi, including Paecilomyces variotti, Fusarium oxysporum, Penicillium species, Rhodotorula mucilaginosa, Trichosporon mucoides, and Exophiala dermatitidis.

His clinical condition deteriorated and the patient died in October 2014. Postmortem examination revealed diffuse alveolar damage consistent with acute respiratory distress syndrome and interstitial fibrosis, attributed to a history of chronic hypersensitivity pneumonitis. The cause of death was an acute ILD flare, and no molds or fungi were isolated in a post-mortem examination.

This is an isolated case, but according to there doctors, other reported cases of hypersensitivity pneumonitis in saxophone and trombone players exist.

“This is the first case report identifying fungal exposure, from a bagpipe player, as a potential trigger for the development of [hypersensitivity pneumonitis],” the researchers wrote, according to a news release.

“The clinical history of daily bagpipe playing, coupled with marked symptomatic improvement when this exposure was removed, and the identification of multiple potential precipitating antigens isolated from the bagpipes, make this the likely cause,” they concluded.

Researchers warn that any type of wind instrument could be contaminated with yeasts and molds, making players prone to hypersensitivity pneumonitis. Cleaning instruments immediately after use and allowing them to drip-dry may, theoretically, reduce the risk of microorganism growth.