Bird Fancier’s Lung (BFL), also called bird-breeder’s lung and pigeon-breeder’s lung, is a subset of Hypersensitivity pneumonitis (HP). This disease is caused by the exposure to avian proteins present in the dry dust of the droppings and sometimes in the feathers of a variety of birds. It is mainly present in bird droppings, however. Birds such as pigeons, parakeets, shell parakeets (budgerigars), parrots, turtle doves, turkeys and chickens have been implicated in its cause. This disease is an inflammation of the alveoli in the lungs in response to the contaminants. Initial symptoms are breathlessness, especially after sudden exertion or when exposed to temperature changes, and can be very similar to asthma. If someone that has been sensitized through consistent, long-term exposure to avian proteins they will usually see symptoms within 4–6 hours of contact through inhalation. Symptoms include chills, fever, breathlessness, non-productive cough, and chest discomfort. In the chronic form there is usually anorexia, weight loss, extreme tiredness and progressive interstitial fibrosis which is the most disabling feature of the disease, as this causes scarring on the lungs which reduces the lungs ability to move air in and out. As a result sufferers have repeated chest infections and ultimately find it difficult to move air in and out of the lungs making it a struggle to breathe. This condition is occasionally even fatal.
The symptoms of pigeon-breeder’s lung improve in the absence of the bird proteins which cause the disease. Therefore it is advisable to reduce or eliminate contact with the offending contaminants. Steroid inhalers similar to those used for asthma are effective in cases where the patient finds inhaling difficult. Recovery varies from patient to patient depending on the length of exposure, the frequency of recurrence of exposure, what stage the condition was at when the patient consulted the doctor, as well as the speed of diagnosis and application of the appropriate treatment to prevent residual damage to the lungs. Some make a full recovery. However, it still may reoccur when in the individual comes in contact with birds or other allergens once again. Tight-fitting respirator masks should be used when cleaning lofts; will reduce the contact with the offending material; and are effective in preventing the disease. In addition, the cleansing of the nasal cavity and sinuses via nasal irrigation after any exposure to dust, feces and bedding material in the pigeon loft will provide additional security in the prevention of this disease.
Nasal irrigation is the personal hygiene practice in which the nasal cavity is washed to flush out excess mucus and debris from the upper airway; the nose and sinuses. The practice is generally well-tolerated and beneficial with only minor side effects. Nasal irrigation promotes good sinus and nasal health. Individuals with chronic sinusitis including symptoms of facial pain, headache, cough, anterior rhinorrhea (watery discharge) and nasal congestion often find nasal irrigation to provide effective relief. In published studies, “daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis”, and irrigation is recommended as an adjunctive treatment for any chronic sinonasal symptoms.
Nasal irrigation is used to treat a wide range of chronic sinus and nasal symptoms; and for chronic rhinosinusitis it is an effective adjunctive therapy. It is also an effective measure against chronic sinus symptoms induced by work-place exposure to sawdust, and in the case of roller enthusiasts, exposure to pigeon bloom, fecal material, dust, mold, mildew, and bedding materials. Further evidence suggests that nasal irrigation causes relief for both hay-fever and the common cold. The neti pot used with a saline solution has been shown to be an effective nasal irrigation technique for hay fever, sinusitis, and other nasal conditions, as well. Daily nasal irrigation with salt water solution (a mixture of 0.9% non-iodized salt, and water warmed to around 98 degrees F/ 37 degrees C, with or without inclusion of a buffering agent such as sodium bicarbonate) is recommended.
Flushing the nasal cavity with salt water promotes ciliary clearance, moisturizes the nasal cavity, and removes encrusted material. In proper proportion, nasal salt water solution with slight acidic pH functions acts as an anti-bacterial irrigant. The flow of salt water through the nasal passage flushes out the dirt, airborne allergens (dust and pollen), pollutants and bacteria-filled mucus.
Salt water flushing also loosens and thins the mucus, making it easier to expel. Without this build-up of mucus, the tiny cilia, or hairs in the nasal passage are able to function more efficiently, pushing excess mucus either to the back of the throat or to the nose to be expelled. Potential allergens or contaminants, plentiful in the pigeon loft, are also removed. Premanufactured dosages of salt water flushing solutions can be purchased, or the user can mix non-iodized salt, with or without a buffering agent such as sodium bicarbonate or baking soda. Treatment guidelines in both Canada and the United States now advocate use of nasal irrigation for all causes of rhinosinusitis and for routine cleansing of the nasal cavity.
A simple method requiring no specialized equipment is to snort water from cupped hands, but this clears little more than the nostrils and can easily result in choking. The application of commercially available saline nasal spray is another simple alternative, but it is relatively inefficient for washing away debris, although it may suffice for simple rehydration of mucous and tissues.
A simple yet effective technique is to pour salt water solution into one nostril and let it run out through the other while the mouth is kept open to breathe, using gravity as an aid. The container used to administer the saline is called a “neti pot”. Neti pots are typically made of metal, glass, ceramic or plastic. They rely on gravity, along with head positioning and repeated practice in order to rinse the outer sinus cavities. Typically they have a spout attached near the bottom, sometimes with a handle on the opposite side. Some users are able to use neti pots without problems, while the sideways positioning of the head can induce vertigo in others. A more advanced variation of the technique involves pouring the same salt water solution into one nostril while the other is held closed, so that the solution runs out of the mouth. It is more challenging than the basic version, but it can allow more thorough irrigation of the nasal cavity and the sinuses.
While nasal irrigation can be carried out using ordinary tap water, it is not recommended if there is any risk that it may be contaminated in any way with bacteria or protozoans. Therefore an isotonic salt water solution is normally used, i.e. water with enough salt to match the tonicity of the body cells and blood. For the same reason, lukewarm water is preferred over cold water, which in addition to irritating nasal membranes can also exaggerate the gag reflex during irrigation. Use of distilled, sterile or previously boiled and cooled water over ordinary tap water is advised. Tap water safe for drinking is not necessarily safe for nasal irrigation due to risk of rare infections from contaminated tap water. As mentioned before, a small amount of baking soda is sometimes employed as a buffering agent to adjust the pH of the irrigating solution to that of the body.
The precise reasons for the efficacy of nasal irrigation are not fully understood, although it is clear that the removal of mucus plays an important role. Damage to the mucociliary transport system is an important factor in the development of sinonasal diseases and pigeon lung, resulting from a stasis of mucus in the sinuses and lungs. There are numerous proteins found in nasal mucus including inflammatory mediators, and many others whose function is not fully understood. Nasal irrigation may decrease inflammation through the removal of mucus, improvement of mucociliary clearance, and removal of thickened mucus that cannot be handled by the cilia.
When incorporated on a regular basis into a routine cleansing of the upper airway, nasal irrigation can help to promote the body’s natural defense mechanisms and help to prevent sensitization of airway tissues which can result in chronic diseases such as pigeon-breeder’s lung.