When a 35-year-old professional trombone player came to the Health Center seeking treatment for a chronic cough, the case wasn’t as simple as it first appeared.
Dr. Mark Metersky, director of the Center for Bronchiectasis Care, quickly learned that the trombonist had been suffering from the recurring cough for approximately 15 years, and prior physicians had not been able to figure out the cause.
“He didn’t have the typical symptoms that would cause a chronic cough. For instance, he didn’t have a stuffy, runny nose or esophageal reflux problems,” explains Metersky. “Allergy testing was negative, and a physical exam and chest x-ray were all normal.”
Environmental causes or side effects from medication were also ruled out. More intense scans and exams still did not reveal the reason for the cough.
But then the musician told Metersky that his symptoms improved significantly when he did not play his trombone for a couple of weeks. He also noted that the periods of more severe symptoms had been when he was playing more than usual.
Metersky immediately suspected that his patient was suffering from hypersensitivity pneumonitis (HP), a lung condition characterized by shortness of breath and a cough, and that his trombone was the culprit (brass players inhale with the instrument at their mouth between measures).
An examination of the inside of the instrument showed innumerable whitish plaques, and a further analysis revealed the presence of mold and/or bacteria contamination.
A few weeks after the musician began immersing his instrument in 91 percent isopropyl alcohol, his cough went away completely.
The case intrigued Metersky enough that he decided to study several other musicians and their instruments.
“All seven musicians had at least one instrument contaminated with either mycobacterial or fungal species previously associated with HP,” he says.
Metersky speculates that since most brass and wind instruments may harbor large numbers of mold and bacteria, many other musicians may be at risk for HP.
The study is published in the Sept. 7 issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
