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In August a usually staid British medical journal published a modest clinical case report to unusually great fanfare. Media worldwide took note of a “new” disease: bagpipe lung.
The name of this novel condition has an almost whimsical connotation. As the medical journal’s promotional press release noted, however, the fatal outcome of the case better characterized tragedy than comic farce: “Doctors writing in the journal Thorax have warned musicians who play wind instruments of a potential hazard they have dubbed ‘bagpipe lung.’ The warning comes after a man 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” (http://thorax.bmj.com/content/suppl/2016/08/19/thoraxjnl-2016-208751.DC1/thoraxjnl-2016-208751_PRESS_RELEASE.pdf).
The specialized medical label “hypersensitivity pneumonitis” required a bit of explaining for journalists handling the popular health beat. For example, Aria Hangyu Chen at CNN lead off with the hook, “Whether playing a wind instrument is your hobby or your job, you may want to watch out for ‘bagpipe lung,’" but went on to explain the basics of hypersensitivity pneumonitis: a serious immunologic condition that can cause irreversible damage to the lungs (http://www.cnn.com/2016/08/22/health/bagpipe-lung-fungi-death-case-study/).
Hypersensitivity pneumonitis is often referred to in medical shorthand by its initials, HP. The case reported in Thorax had much in common with many others attacked by severe HP. He first had been diagnosed with the condition in 2009, already symptomatic for some time before that. Yet even though his doctors knew he had HP, they could not identify the trigger. This is a common story in HP. Pigeon or other bird exposure, especially among hobby pigeon racers or devoted pet bird owners, was excluded. And there was no obvious water damage or mold infestation in the home. By the fall of 2014, the patient had gone downhill to the point where he was admitted for a terminal hospitalization.
In the interval between 2009 and 2014, a key event had transpired: in 2011 the patient had spent three months in Australia. There was a notable improvement in his symptoms, only to recrudesce upon his return to England. Too late, it emerged that the he was an avid bagpipe player and had left them back at home during his sojourn down under. The doctors went so far as to take the implicated bagpipes, inflate and squeeze them (in a safety cabinet) in order to sample for mold. Multiple mold species were isolated, more than one known to be linked to HP.
The word choice “bagpipe lung” is solidly in the tradition of medical writing about HP. Indeed, in 2010 two different cases of HP in musicians playing other wind instruments (one saxophone, one trombone) were noted in the U.S. journal Chest, with the accompanying medical editorial slyly titled “Wind-Instrument Lung; A Foul Note” (http://journal.publications.chestnet.org/article.aspx?articleid=1045040). Other colorful HP syndrome names include “maple bark stripper’s lung” (one of first well described case outbreaks, dating back to the 1930s), “bagassosis” (not a miner’s disease but rather a condition among sugar cane processors exposed to bagasse, that is, cane waste), and the all too common “bird-fancier’s lung.”
The dark subtext of this light-hearted naming convention is that is belies a potentially lethal and wholly preventable environmental-occupational illness. The culprit can be a hazard in the structure of the home (which is why water damage leading to mold was an initial concern in this case), in household hobbies or avocations, or on the job. For farmers, among whom “farmer’s lung” due to moldy hay is important, work and home are one in the same (which could also be true for a home office that also is graced with an implicated pet bird).
But in the particular case of the patient with bagpipe lung who died in 2014, unnamed of course in the medical article, there was an even sadder, unspoken part of the story. As the London Times reported two weeks after the Thorax paper played around the globe, “A hospital has had to apologize to a musician’s family after they discovered that this death was connected to his bagpipe playing only after reading about it in a medical journal” (http://www.thetimes.co.uk/article/hospital-says-sorry-over-bagpiper-s-d…).
The patient’s name, we learn from the Times report, was Bruce Campell; he was bagpipe teacher and editor of the magazine Piping World.
