Brass Instruments Can Cause Lung Disease

Sept. 7, 2010— -- That saxophone player can sure play the blues, but his instrument may be getting green.

Brass musicians may unknowingly inhale mold and bacteria from their instruments, which may lead to the development of hypersensitivity pneumonitis (HP), according to a study published today in Chest magazine.

The allergic lung condition, which can develop into a more dangerous fibrosis, is characterized by shortness of breath and coughing.

In two separate reports, researchers from the United States and Europe identified cases of HP in a 35-year-old patient who played the trombone and in a 48-year-old saxophone player.

In both cases, patients had no other medical or environmental exposures that seemingly could have led to the condition.

In the French and Belgian study, a 48-year-old office clerk who played saxophone as a hobby was diagnosed with HP. A white collar worker, he had played the instrument as a hobby and had experienced symptoms for five months. Later, two molds were found in his saxophone.

American scientists at University of Connecticut Health Center and University of Texas Health Science Center at Tyler documented the case of a 35-year-old with "trombone player's lung." He had a nonproductive cough for 15 years with no other medical explanation.

When he stopped playing for two weeks, the symptoms lifted. Later, his instrument was found to be contaminated with fungal and elements and bacteria.

Neither man had allergies or exposure to allergens like pets or drugs. When each musician cleaned his instrument, the symptoms of HP disappeared.

Researchers speculate that since most brass and wind instruments may harbor large numbers of mold and bacteria, many other musicians could be at risk for HP.

"This isn't shocking, nor do I think it's very common," said Dr. Martin Blaser, chairman of medicine at New York University and a specialist in infectious diseases. "My guess is these are isolated events and somebody got unlucky."

"But maybe some instruments are brewing something and perhaps it's a harbinger of a bigger problem," he said.

Hypersensitivity pneumonitis is a general term that refers to inflammation of lung tissue, according to the Mayo Clinic

Although pneumonia is technically a type of pneumonitis because the infection causes inflammation, most doctors are referring to other causes of lung inflammation when they use the term "pneumonitis."

Factors that can cause pneumonitis include exposure to airborne particles in the workplace, such as asbestos or silica; some drugs, particularly chemotherapy ones; radiation therapy to the chest, exposure to poultry, pigeons or pet birds; and many types of mold.

Because of the association with birds and with chemicals, the condition is sometimes referred to as "farmer's lung" or "hot tub lung." Sometimes ingested food or liquid can also cause pneumonitis.

Symptoms include difficulty breathing, often with a cough, and sometimes fever, but specialized tests are necessary to make a diagnosis. For many people, the offending substance causing the inflammation is never identified.

"HP is just what it sounds like," said Blaser. "It's a hypersensitivity or allergic phenomena that causes an inflammation of the lungs and has been described for a long time with many different causes."

"Generally, there are environmental causes, such as the classic one with people who are exposed to moldy grain in silos or cotton fibers or certain other molds," he said. "Sometimes it's certain metals like beryllium."