"Two months after the onset of symptoms, I could not stand or walk for more than a few minutes at a time without feeling like I was going out," wrote 43-year-old Martin Taylor of Aberdeenshire, Scotland, in a case study published in Monday in BMJ Magazine.
"Going up to bed was 30 minutes activity because I could only manage two steps at a time and then I had to sit and rest, "Taylor added.
Four doctor's appointments failed to find the cause, which was "extremely disturbing," wrote Taylor, who never smoked. Since his health failed, he stayed home from work and He spent most days and nights sleeping.
At the moment Taylor did not know she was suffering from hypersensitive pneumonitis a disease in which the lungs become inflamed as a result of an allergic reaction. Bitten early, the disease is easily treatable. Undiagnosed, it can lead to permanent lung scarring and even death.
Unfortunately, in Taylor's case, the doctors he saw for the first time have no idea of the cause.
Time for Dr. Sherlock
Taylor was first treated for infection of the upper respiratory system. But his health continued to decline over the next three months. Then, the radiologist rejected X-rays of the lungs as normal.
Concerned, his family doctor called an emergency respiratory clinic and talked to Dr. Owen Johnnons Dempsey, a chest consultant at BMI Albin Hospital in Aberdeen, Scotland, about a 30-minute drive from Aberdeenshire.
"His GP was very discerning in not accepting the chest X-ray value of a person's face," Dempsey said, adding that it could be difficult to diagnose hypersensitivity pneumonitis because the changes are often subtle with only "minor" Diffuse Lung Growth »
"I think the radiologist may have thought it was a little 'subjected' to chest radiation," Dempsey said.
Dempsey grabbed the phone and strangled Taylor.
"He was sounding very breathless, just walking from one room to his house to another," Dempsey said. "Very abnormal for such a young man. It was clear that the patient had progressive and indeed very disabling breath, now interfering with activities of daily living. "
Diagnosing is "a bit of a jigsaw puzzle," Dempsey said. One of the first clues was Taylor's work in the blood, which showed that his immune system was exposed to bird protein. However, Taylor told Dempsey that he did not own any birds, only a cat and a dog.
"I have a particular interest in this group of diseases," Dempsey said. "And we know that if you have a precise history, you can often identify environmental triggers for lung disease."
Dempsey pigeon deeper: Taylor lived in a warm, dry house with his wife. They had a loft, which he didn't visit much, but they had a bathroom with a little mold over a shower and a window. He did not travel to another area. He had no history of medication. Worked in an office with no apparent exposure. And he played guitar and sax in a local band.
"We are paid to be uncomfortable," Dempsey said. "The danger is that we are not asking enough and we assume that the diseases are 'idiopathic' or unexplained. If so, we miss the trick and our patients undergo unnecessary tests or treatments. "
Finally, Dempsey's questions turned to dirt: The couple recently replaced their synthetic bedding with feather and pillow pads. Taylor had lung disease.
As Sherlock would say, "Primarily, my dear Watson."
Lung disease of the lungs
Bird allergies are not uncommon. Often called bird hunting asthma, symptoms can range from severe cough, runny nose and eye irritation to asthma to more serious complications such as Taylor. People with allergies are at greatest risk when they are cleaned of cages or birds, and during the year when the birds grow and shed their feathers.
Lung disease of the lung is a subset of bird hunting asthma and is difficult to diagnose because of its rarity and wide variety in the timing and type of symptoms.
The onset of symptoms after exposure to new towel or pillow towels can range from three weeks to five years. Difficulty in breathing can increase over time, and the patient may have night sweats, dry cough, fainting and fever. The condition is often misdiagnosed if the person does not report birds in the home, and many doctors do not consider asking for bedding.
"Most doctors, in my experience, don't ask that level of detail," Dempsey said, adding that doctors should always ask for exposure at home, including bedding, molds, home heat and dryness, and any unusual hobbies or pastimes.
Early detection of exposure to avian antigens and removal of bedding or other irritants is key to recovery for patients, Dempsey said.
While studies did not always support the use of steroids, they were successful in this situation, especially since Taylor also removed the bedding with feathers.
"The steroids that were prescribed after the diagnosis … had a transformative effect within two days," Taylor wrote. "The course of steroids continued for about 12 months, with the dose gradually decreasing over time. Fortunately, I was able to completely stop them.
"I don't have any dizzy spins from recovery. It doesn't affect me at all and my life is pretty much the same as before. "