Doctors have warned musicians who play wind instruments that they could be susceptible to a potentially fatal lung condition if they don’t wash their instruments properly.
Writing in the BMJ, experts said that moist interiors such as those found inside wind instruments may foster growth of fungi and moulds linked to inflammatory lung disease.
They dubbed the potential health hazard ‘bagpipe lung’.
Their warning comes after a man died of the chronic inflammatory lung condition hypersensitivity pneumonitis, which was thought to have been caused by regularly breathing in mould and fungi lurking inside a set of bagpipes.
Doctors described the case of a 61-year-old man who had had a dry cough and progressive breathlessness, despite treatment with immunosuppressant drugs, for seven years.
His condition had worsened to the point that he couldn’t 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.
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. But in a significant proportion of cases, it’s not always clear what has triggered it.
In the case of the 61-year-old man, doctors discovered that he did not work with pigeons, nor did his house harbour mould or show signs of water damage. He had also never smoked.
They did find, however, that he played the bagpipes daily as a hobby.
During a three month trip to Australia in 2011, during which time there was no bagpipe playing, the man’s 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, and a post mortem examination revealed extensive lung damage consistent with acute respiratory distress syndrome and tissue fibrosis.
This is an isolated case, and the cause of the man’s condition was not definitively proved, but there have been other reported cases of hypersensitivity pneumonitis arising in trombone and saxophone players, the 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 wrote.
“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 warned that any type of wind instrument - whether that’s brass or woodwind - could be contaminated with yeasts and moulds, making players susceptible to the risk of hypersensitivity pneumonitis.
Although there isn’t any guidance on the optimal hygiene regimen, experts said cleaning instruments immediately after use and allowing them to drip dry could theoretically curb the risk of microbe growth.
They concluded that both doctors and musicians need to be aware of this potential hazard and the importance of good instrument hygiene.