Playing wind instruments behind deadly 'bagpipe lung' hazard

Musicians who play wind instruments may be at the risk of developing a potentially fatal condition called 'bagpipe lung', doctors in the UK have warned.
The warning comes after a 61-year-old man in the UK died of the chronic inflammatory lung condition hypersensitivity pneumonitis - thought to have been caused by regularly breathing in mould and fungi lurking inside the moist interior of a set of bagpipes.
Hypersensitivity pneumonitis is triggered by the immune system's response to an inhaled environmental antigen and can progress to disabling or fatal lung disease.
It is often associated with occupational exposure to birds, particularly pigeons. However, in a significant proportion of cases, it is not always clear what triggered it.

The researchers from Queen's University Belfast in the UK described the case of the man who in 2014 had a dry cough and progressive breathlessness, despite treatment with immunosuppressant drugs, for seven years.
His condition had worsened to the point that he could not walk more than 20 metres, and was finding it hard to breathe, prompting admission to hospital.

He had been diagnosed with hypersensitivity pneumonitis in 2009, although the cause had not been identified: he was not a pigeon fancier, nor did his house harbour mould or show signs of water damage. He had never smoked, doctors said.

However, he played the bagpipes daily as a hobby, and did not take them with him on a three month trip to Australia in 2011, during which time his symptoms rapidly improved.
This prompted samples to be taken for testing from several areas inside the bagpipes, including the bag, the neck, and the chanter reed protector.
The samples grew various different fungi, including Paecilomyces variotti, Fusarium oxysporum, Penicillium species, Rhodotorula mucilaginosa, Trichosporon mucoides and Exophiala dermatitidis.
Despite treatment, the man died. A post mortem examination unveiled extensive lung damage consistent with acute respiratory distress syndrome and tissue fibrosis (scarring).
This is an isolated case, and the cause of the man's condition was not definitively proved. However, there have been other reported cases of hypersensitivity pneumonitis, arising in trombone and saxophone players, doctors said.

"This is the first case report identifying fungal exposure, from a bagpipe player, as a potential trigger for the development of (hypersensitivity pneumonitis)," they said.
"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 said.
Researchers warned that any type of wind instrument could be contaminated with yeasts and moulds, making players susceptible to the risk of hypersensitivity pneumonitis.
The research was published in the journal Thorax.