Doctors say ‘bagpipe lung’ is a very real risk for players of wind instruments.

The warning comes after a man died of the chronic inflammatory lung condition hypersensitivity pneumonitis—which is linked to regularly breathing in mould and fungi that lurk 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. But in a significant proportion of cases, the cause is not always clear.

The doctors describe the case of a 61 year old man who in 2014 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 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 either.

But the man did play the bagpipes daily as a hobby, though they were not 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 mucoidesand Exophiala dermatitidis.

Despite treatment, the man died: a post mortem examination revealed extensive lung damage consistent with acute respiratory distress syndrome and tissue fibrosis (scarring).

“This is the first case report identifying fungal exposure, from a bagpipe player, as a potential trigger for the development of [hypersensitivity pneumonitis],” experts write in an article for the British Medical Journal.

“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 conclude.

They warn that any type of wind instrument could be contaminated with yeasts and moulds, making players susceptible to the risk of hypersensitivity pneumonitis.

Although there is no specific guidance on the optimal hygiene regimen, cleaning instruments immediately after use and allowing them to drip dry could theoretically curb the risk of microbe growth, they suggest.

But both doctors and musicians need to be aware of this potential hazard and the importance of good instrument hygiene, they conclude.