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Mark L. Metersky, MD, FCCP; Scott Bean, MM
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Metersky), University of Connecticut School of Medicine; and the Music Department (Mr Bean), Central Connecticut State University.

Correspondence to: Mark L. Metersky, MD, FCCP, Division of Pulmonary and Critical Care Medicine, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030-1321; e-mail: Metersky@nso.uchc.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):729-730. doi:10.1378/chest.10-2870
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To the Editor:

We would like to thank Drs Rackley and Meltzer for their interest in our recent report in CHEST (September 2010)1 of a patient with hypersensitivity pneumonitis (HP) due to use of a trombone colonized with Fusarium sp. and Mycobacterium chelonae/abscessus group organisms. Although we do not think we were guilty of overemphasizing the role of wind instruments in HP, or stigmatizing wind instruments, Drs Rackley and Meltzer correctly caution pulmonologists against assuming that a wind instrument is always the cause of pulmonary symptoms or interstitial lung disease in an exposed patient. A complete exposure history is always important, as more than one potentially relevant exposure may occur. This is especially true in the case of wind instruments. Hundreds of thousands of children and adults are regularly exposed in the United States, and the vast majority do not develop HP.

Although we would no more wish to stigmatize all wind instruments than Drs Rackley and Meltzer would stigmatize all bathrooms, wind instruments, like bathrooms, provide the perfect environment for the growth of pathogenic organisms. The inside of a wind instrument is warm and moist and provides nutrients in the form of desquamated cells (seen in the biofilm from the instruments we studied) and saliva that are introduced into the instrument during use. The magnitude of contamination of these instruments is quite extreme. Assuming that one organism visible per 100 × field is approximately equivalent to 106 organisms/mL,2 the biofilm obtained from several of the instruments we studied contained >108 organisms/mL, higher than the colony count seen in most outbreaks of HP due to contaminated metalworking fluids and hot tubs.3,4

Although the likelihood of wind instrument-related disease is low in any single individual, given the large number of exposed individuals and the degree of contamination, it is highly likely that there are substantial numbers of afflicted persons. Our report received significant attention in the lay press and prompted responses from more than one musician who recounted similar respiratory symptoms that remitted when they started to more diligently clean their instruments. Other musicians pointed out prior reports of similar illness in bagpipers, previously referred to as piper’s lung. We reiterate our conclusion that pulmonologists should consider the possibility of HP in wind musicians who have suggestive respiratory complaints, with or without obvious interstitial lung disease.

Metersky ML, Bean SB, Meyer JD, et al. Trombone player’s lung: a probable new cause of hypersensitivity pneumonitis. Chest. 2010;1383:754-756. [CrossRef] [PubMed]
 
Rodrigues Camilla. Laboratory diagnosis of tuberculosis. http://www.expresshealthcare.in/200906/labwatch10.shtml. Accessed November 6, 2010.
 
Kreiss K, Cox-Ganser J. Metalworking fluid-associated hypersensitivity pneumonitis: a workshop summary. Am J Ind Med. 1997;324:423-432. [CrossRef] [PubMed]
 
Lumb R, Stapledon R, Scroop A, et al. Investigation of spa pools associated with lung disorders caused by Mycobacterium avium complex in immunocompetent adults. Appl Environ Microbiol. 2004;708:4906-4910. [CrossRef] [PubMed]
 

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References

Metersky ML, Bean SB, Meyer JD, et al. Trombone player’s lung: a probable new cause of hypersensitivity pneumonitis. Chest. 2010;1383:754-756. [CrossRef] [PubMed]
 
Rodrigues Camilla. Laboratory diagnosis of tuberculosis. http://www.expresshealthcare.in/200906/labwatch10.shtml. Accessed November 6, 2010.
 
Kreiss K, Cox-Ganser J. Metalworking fluid-associated hypersensitivity pneumonitis: a workshop summary. Am J Ind Med. 1997;324:423-432. [CrossRef] [PubMed]
 
Lumb R, Stapledon R, Scroop A, et al. Investigation of spa pools associated with lung disorders caused by Mycobacterium avium complex in immunocompetent adults. Appl Environ Microbiol. 2004;708:4906-4910. [CrossRef] [PubMed]
 
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