Doctors warn of potential harm from wind instruments



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Even with the best of intentions, proper hygiene is sometimes a difficult thing to attain. Bacteria and other dangers can lurk in the oddest of places and, in time, can cause serious problems. A team of doctors writing in the journal Thorax have warned musicians who play wind instruments of a potential hazard they have dubbed "bagpipe lung."


Persistent symptoms

The warning concerns a condition called hypersensitivity pneumonitis (HP), a chronic lung inflammation that can be triggered by the inhalation of environmental antigens. This can mean disabling or even fatal lung disease. The illness has previously been associated with occupational exposure to birds, particularly pigeons. In a significant proportion of cases, bagpipeshowever, it's not clear what has triggered the reaction.

The new warning comes after the recent death of a man who it is thought had breathed in mold and fungi from a set of bagpipes. Despite receiving treatment with immunosuppressant drugs, by 2014, the 61-year-old man had had a dry cough and progressive breathlessness for seven years. Eventually, his breathing difficulties worsened to the point that he couldn't walk more than 20 meters and he was admitted to hospital.


Delayed diagnosis

The man had been diagnosed with HP in 2009, despite their being no obvious cause. He had never smoked, he did not keep pigeons and there was no sign of mold or water damage in his house. He did, however, play the bagpipes. Although he practiced daily as a hobby, when he took a three-month trip to Australia in 2011, he understandably left the bagpipes at home. During this trip, the symptoms rapidly improved.

When he returned, samples were taken from several areas inside the bagpipes, including the bag, the neck and the chanter reed protector. When these were tested, the samples grew various different fungi, including Paecilomyces variotti, Fusarium oxysporum, Penicillium, Rhodotorula mucilaginosa, Trichosporon mucoides and Exophiala dermatitidis. Despite these discoveries and further treatment, the man died. He was discovered to have had extensive lung damage consistent with acute respiratory distress syndrome as well as fibrosis.


Rare cases

Such lung diseases are rare. Although the exact figures are not known, according to the National Institutes of Health, the figure for so-called "interstitial" lung diseases stands at around 30 in 100,000. HP accounts for less than 2% of these cases, they say. "This is the first case report identifying fungal exposure, from a bagpipe player, as a potential trigger for the development of [HP]," say the researchers. "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, makes this the likely cause."

Though, in this case, the cause of the condition was not definitively proved, there have been other reported cases of hypersensitivity pneumonitis occurring in trombone and saxophone players. The doctors say any type of wind instrument could theoretically be contaminated with yeasts and molds, making players susceptible to the risk of the condition.

Although we don't have any clear guidance on the best hygiene regime, cleaning instruments immediately after use and allowing them to drip dry could theoretically curb the risk of microbe growth, the authors say. They also suggest both doctors and musicians need to be aware of this potential hazard and the importance of good instrument hygiene.