Bagpipe Lung – a piper-MD’s perspective

The Background

The case describes a 61-year-old man who presented in 2014 with a seven-year history of a cough and increasing shortness of breath. He had previously undergone investigation with imaging and biopsies which confirmed the diagnosis of Hypersensitivity Pneumonitis. He was being referred for more specialist care.

Hypersensitivity Pneumonitis (also known as extrinsic allergic alveolitis) is a spectrum of inflammatory lung conditions that affect the ability of the lung to pass on the oxygen we breathe in to the blood. This inflammation occurs with repeated inhalation of a specific allergen to which the person is highly susceptible. Prolonged exposure can lead to scarring of the lungs, which is usually irreversible.

It is most commonly seen in those who keep birds (“Bird Fancier’s Lung”) and in farmers (“Farmer’s Lung”), as they are repeatedly exposed to bird feathers and hay, respectively, which are both recognized causes. It is a rare condition, however, with the prevalence (i.e., the number affected at any one time) being reported to be as few as 420 people per 100,000 at risk in the UK⁽⁹⁾ with similar numbers in North America. However, it can be difficult to diagnose such conditions and so this figure is likely to be higher.

If playing bagpipes is to be considered a recognized cause, then it would be important to assess thoroughly the evidence for this, which in this case would be in the form of the original article published last summer.