'Bagpipe lung' death a warning to wind instrument players

Musicians take heed: not regularly cleaning wind instruments could support the growth of fungi that lead to "bagpipe lung," say doctors reporting a rare, fatal case.

Instruments could be contaminated with yeasts and moulds that act as a potential trigger

Musicians take part in the 2016 World Pipe Band Championships qualifiers in Glasgow, Scotland. Cleaning the instrument immediately after use and allowing it to drip-dry would theoretically reduce the risk of microbial growth that can lead to a lung disease, doctors say. (Ross Gilmore/Getty)

Musicians take heed: Wind instruments need to be cleaned regularly to prevent the growth of fungi that can cause "bagpipe lung," say doctors who reported a rare, fatal case.

In Monday's issue of the journal Thorax, doctors describe the case of a 61-year-old man in the U.K. who had a dry cough and worsening breathlessness, despite treatment, for seven years.

He had a previous diagnosis of hypersensitivity pneumonitis (HP), a chronic inflammatory lung disease triggered by the immune system's response to an inhaled protein from the environment. 

He never smoked and his house didn't have mould or signs of water damage.

The illness is often associated with occupational exposures, such as among people who work with pigeons and breathe in particles from their feathers or droppings. The man wasn't a pigeon fancier.

His condition worsened to the point he was limited to walking 20 metres. He was finding it hard to breathe before his admission to hospital, Dr. Jenny King of University Hospital South Manchester and her co-authors wrote.

His symptoms improved dramatically during a three-month trip to Australia in 2011. He was able to walk 10 kilometres on the beach without stopping.

But when he returned to the U.K., his breathing deteriorated rapidly.

What was different? The man played the bagpipes daily as a hobby, but he didn't take the instrument to Australia.

"This is the first case report identifying fungal exposure, from a bagpipe player, as a potential trigger for the development of HP," King and her co-authors wrote.

Best way to clean unclear

They determined his favourite instrument was the likely cause based on his history of playing it almost daily, coupled with how his symptoms improved when he took a break while on vacation, and because of the fungi found on samples taken from the bagpipes' reed, back and neck.

"Feasibly any wind instrument or brass instrument could have these moulds or fungi and although not everybody who plays it who is exposed will get this condition, there is a possibility by exposing yourself that you could develop it," King said in an interview with CBC Radio's As It Happens.

"So I think it's really important that people who play these instruments are aware that there is a risk and clean their instrument regularly and are also very aware if they get any respiratory symptoms it's important to go straight to your doctor to report it."

A busker plays bagpipes along the bank of the Thames in central London. Wind instruments like bagpipes need to be cleaned regularly to prevent fungi growth, doctors say. (Suzanne Plunkett/Reuters)

There have been previous cases reported in the medical literature of the illness in saxophone and trombone players attributed to fungi and yeast.

King said this sort of lung condition has hundreds of causes and risk factors. If there is a lot of inflammation in the lungs, it leads to scarring, which is irreversible and ultimately fatal.

Ian Goodtimes, a professional bagpiper from Toronto, said he thinks the instrument is supposed to be cleaned out with disinfectant once a year.

"I rarely do it at all. There is also this gross bagpipe seasoning to keep the inside airtight," Goodtimes said in an email. 

The U.K. authors suggest cleaning an instrument as follows: 

  • Take the instrument apart piece by piece.
  • Use a brush and a disinfectant and water solution to clean each piece.
  • Allow the parts to drip dry.

But King admits there is no gold standard way to clean an instrument.

The optimum drug therapy to try to prevent the progression of HP is also unclear. 

Despite the warning, the authors aren't recommending anybody quit playing music.

"We're just suggesting having this awareness can only make playing a more safe and enjoyable activity for everybody."