Play a Wind Instrument? Beware 'Bagpipe Lung'

Musicians, make sure you clean those instruments.

Players of wind instruments, such as bagpipes, trumpets, and trombones, are at risk of getting a rare lung condition if they don’t clean the instruments regularly.

The condition is called hypersensitivity pneumonitis, or HP. It is treatable, and most musicians won’t get it. But it can be deadly if not treated: A new case study tells of a 61-year-old bagpipe player who died of  the chronic inflammatory lung condition thought to have been caused by fungi growing inside his dirty bagpipes.

Study author Jenny King of University Hospital of South Manchester in the U.K. says an allergic reaction to substances such as mold, fungi, or bacteria brings on the condition, causing a patient’s lungs to get stiff and making breathing difficult.  Besides instruments, the substances are found in bird droppings, hay or animal feed, hot tubs, air conditioner systems, contaminated foods such as grapes and cheese, and other sources.  

Doctors treat the condition by stopping exposure to whatever is causing it and giving drugs to suppress the immune system, she says.

Doctors treating it often do not think to ask if their patients play wind instruments. They may focus on other causes, such as bird droppings and pigeons -- which have been linked to the condition -- or occupational exposures such as hay or grains on farms, called “farmer’s lung.” Experts estimate that farmer's lung could affect up to 7% of those who farm.

Anyone who plays wind instruments, which require blowing into them and then inhaling, is potentially at risk, King says.

Mark Metersky, MD, professor of medicine and director of the Center for Bronchiectasis Care at UConn Health, published a similar report in 2010 about “trombone player's lung” as a cause of the condition. The study said that “many brass musicians are at risk for HP from contaminated instruments.”

"It's an allergic reaction to the microorganisms that are growing in the instruments and being inhaled," he says. "Just like everyone is not allergic to cats or bees, it doesn't bother everyone,"

He says the vast majority of wind instrument players will not get it. When they do, dry cough is the most common symptom. Others include shortness of breath and fever, Metersky says.

The Bagpipe Player's Story

Doctors diagnosed the condition in the bagpipe player and prescribed medication, but could not figure out the source and didn’t know why his symptoms of dry cough and breathlessness did not improve, King says. They never asked him about wind instruments, however; the man played bagpipes daily.

When the man visited Australia for three months, leaving his bagpipes at home, his symptoms improved. Once back in the U.K., he resumed playing and the symptoms returned. That prompted the doctors to take samples from the bagpipes. They found several species of fungi growing inside. Even with treatment, the man died of respiratory complications, King says.

Advice for Wind Instrument Players

Anyone who plays a wind instrument should be stringent about cleaning it, preferably each time they are played, King says.

The problem is, she says, ''there isn't a recommended universal way to clean the instruments."

She recommends this: "Take it apart piece by piece. Use detergent and warm water. Allow it to drip dry."

One of Metersky's patients, a trombone player, cleaned his instrument with rubbing alcohol and found that his symptoms of cough and breathlessness improved.

Regular cleaning is a must, agrees MeiLan Han, MD, a lung specialist and associate professor at the University of Michigan, who is also a spokeswoman for the American Lung Association.

"Just like anything else you put into your mouth," she says, instruments ''need to be cleaned. Mold can grow and cause lung disease."

Han says that she has seen cases of hypersensitivity pneumonitis but that musical instruments have not been recognized as a top cause. The new report, as well as previous ones, should be a wake-up call, she says.

She says she has not been asking routinely about musical instrument habits when diagnosing patients with lung problems, but ''this article makes me think I probably should."


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