Beware Of “Saxophone Lung”?

OK, I admit it. Had I not originally come across the term “Saxophone Lung” on a medical site, I would have thought it was a joke, but a bit of Googling turned up a host of articles on both Google and Google Scholar.

The original article I came across was published November 17, 2013, on Medscape. It was titled, Playing Dixie Leads to Saxophone Lung in Clarinet Player. The introduction of the article goes as follows:

BALTIMORE — A wheezing Atlanta clarinet player, who had been playing Dixie for 30 years, was diagnosed with saxophone lung after a year of symptoms that did not improve with treatment from inhaled corticosteroids [anti-inflammitories] and bronchodilators or oral antibiotics.

“It had been missed by previous physicians who, based on the fact that he had been coughing and wheezing for a year, just treated his symptoms,” said Marissa Shams, MD, who saw the patient at the Emory University Adult Asthma, Allergy and Immunology Clinic in Atlanta, Georgia.

“He was playing the clarinet several times a week and he noticed that after he played, his symptoms would get worse,” she told Medscape Medical News. “We got a CT scan, and it showed these very significant and abnormal findings of bronchiectasis and mucus plugging within his airways.”

What was the cause of the patient’s Saxophone Lung? His moldy clarinet that hadn’t been cleaned for 30 years!

OK, that’s just pretty disgusting. Not to mention that there was also a type of fungus growing on the guy’s reed.

Is anyone else out there wanting to yell: CLEAN YOUR FREAKIN’ INSTRUMENT!

BTW, the patient’s condition finally improved after not only medical treatment, but instrument sterilization and a new reed.

Saxophone Lung has made the mainstream, with sites like Huffington Post offering up their non-medicalese version of the story.

In the Huffpost they also mention a saxophone player whose shortness of breath cleared up after he started cleaning his mouthpiece.

What’s up with these players? Do you want to put your mouth on a dirty, smelly mouthpiece/reed, that is attached to a horn that hasn’t been cleaned in years? I certainly don’t. As a matter of fact, that’s one of the reasons I budget for an overhaul for all used or vintage horns that I buy. This way I know that my tech has scrubbed out the body tube.

I also brush my teeth before I play, and don’t drink anything other than water while playing. After playing, I use a silk pull-through on my horns, and then let them air dry in their stands.This reduces the amount of crud in my horn, and reduces the bacteria and fungi that grow in them. Also, it extends the time that I need between overhauls (read scrubbings).

According to all the articles that I have read, true Saxophone Lung is rare, but I remember having a lot of running nose type stuff when I was in junior and senior high. (During the period of my life when I was using school band instruments.) It was the only time in my life when it seemed like I had allergies. Maybe the General Dentistry study published in 2011, which showed 295 different bacteria as well as yeasts and molds growing on 13 school band instruments, explains my symptoms? 💡

BTW, in case the fear of bacteria, yeasts, and fungi aren’t enough to get the hypochondriac in you cranked up  😉 , here’s another thing for you to stress about. According to Dr. Michael Kreuter, from the Thoraxklinik in Heidelberg, Germany:

…simply playing a wind instrument can carry pneumologic risks, fungal spores aside.

“Depending on the type of wind instrument, the required rates of airway pressure and air flow differ significantly,” he explained in a review (Pneumologie 2008:62:83-87). “The cause of respiratory disease in wind instrument players may be related to these increased airway pressures in terms of a barotrauma. Wind instrumentalists may suffer from hemoptysis, laryngoceles, velopharyngeal insufficiency, and pneumoparotitis due to their musical performance. Even the development of lung cancer has been assumed to be related to wind instrument playing.”

But these risks, along with the very low probability of developing saxophone lung from moldy instruments, should be considered against the many advantages of wind instrument playing, Dr. Kreuter added during an interview.

Source: “Playing Dixie Leads to Saxophone Lung in Clarinet Player”, November 17, 2013  Medscape Multispeciality

If you’d like to read a few more journal articles about Saxophone Lung, here are a few that I used in preparing this article:

“Hypersensitivity pneumonitis: Current concepts and future questions”, August 20, 2001. The Journal Allergy and Clinical Immunology

“Hypersensitivity Pneumonitis Due to Molds in a Saxophone Player”, September 2010. Chest Journal.

“Hypersenstivity Pneumonitis in a Saxophone Player”, Communications to the Editor. journal.publications.chestnet.org

For a nice, brief, non-medical summary, check out the following:

“Instrument neglect can lead to ‘saxophone lung’ in musicians”, November 8, 2013. EurekAlert!