FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

FARMER’S MALADY LINKED TO "PHARAOH'S CURSE"

Question: My husband was having breathing troubles that were so bad our doctor put him in the hospital and did many tests. He finally determined that he has “farmer’s lung.” The doctor didn’t give him any medicine. Instead, he told him that his breathing would slowly get better, which it has. Why didn’t the doctor give my husband any medication to help him get better?

Answer: Farmer’s lung is an allergic-like reaction that can be triggered by different microorganisms. The most frequent causes are a group of bacteria called Actinomycetes and a family of molds called Aspergillus. Because these microorganisms grow in hay or grain, farmers who handle these crops -- particularly in areas without good ventilation -- are more likely to develop the condition. Fortunately, not everyone who is exposed to either these molds or bacteria comes down with farmer's lung. Only those with particular sensitivity actually develop the illness, just as your unfortunate husband has.

Farmer's lung -- as well as several other lung conditions that are due to hypersensitivity reactions -- may begin with symptoms that are indistinguishable from those associated with such disorders as bacterial pneumonia, viral pneumonia, sarcoidosis and heart failure. Sometimes farmer's lung begins as a very acute illness with fever, coughing, shortness of breath and other signs of respiratory infection, usually within eight hours of exposure. In other cases it begins rather insidiously with the gradual development of shortness of breath, coughing, wheezing and chronic tiredness. Inorganic lung irritants like asbestos and silica can also produce similar symptoms. That is why your husband's doctor needed to do a number of tests before the diagnosis was confirmed.

Other bacteria in the Actinomycetes family can cause illnesses with descriptive names like pigeon breeder's disease, bird fancier's disease, and humidifier lung disease. The hypersensitivity pneumonia from Actinomyces was even responsible for the fabled "Mummy's Curse" of King Tut's tomb. You see, George Edward Stanhope Molyneux Herbert, the fifth Earl of Carnarvon, developed a "strange illness" and died shortly after being in the newly discovered tomb in 1922. His untimely death created the fertile ground upon which the rumor grew. Only after many others developed similar but less severe illnesses was it discovered that the tomb floor as well as the mummy wrappings were heavily infested with Actinomyces. Lord Carnarvon died of an acute hypersensitivity pneumonia -- not from a mummy's curse.

Your husband's doctor didn't prescribe any medication because no medication consistently helps this condition. In very acute episodes, the medication prednisone is often used, but it is of no value when the symptoms are milder. The most effective treatment is avoidance of the offending agent. This usually gives prompt recovery for those with their first episode of hypersensitivity pneumonia. For those who have had multiple episodes or who have the chronic form of the condition, there is no treatment -- including avoidance -- that brings much relief.

In your husband’s case, this means he should avoid moldy hay and grain forever. Better ventilation in the barn helps decrease the concentration of the offending microorganisms in the air, while making sure the hay is sufficiently dry before it is baled and that it is stored properly greatly reduces the amount present in the hay itself. High-efficiency face masks can also reduce the amount of mold or bacteria inhaled. These steps are often sufficient to prevent repeated attacks of farmer's lung.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.