Expert warns of alarming rise in lung diseases linked to pigeon exposure

KARACHI: An alarming rise in lung disease cases linked to pigeon exposure is being reported in the city, with young housewives and the elderly bearing the brunt.

Known as Bird Fancier’s Lung (BFL), this condition afflicts many, leaving many struggling to breathe in what should be the safety of their homes.

BFL is a serious condition of global incidence that affects people who handle pigeons, finches, Australian parakeets, cockatoos, and even sometimes turkey, geese, and chicken. Major hospitals across Karachi are reporting a rising trend.

“The Aga Khan Hospital has observed an increasing trend of this disease among young housewives and the elderly who have become exposed to airborne allergens,” Associate Professor of Pulmonary and Critical Care Medicine, AKU, Dr Muhammad Irfan, said.

Over the years, Professor Irfan said, the number of patients with acute or chronic conditions has risen alarmingly. “Ten years ago it used to be one to two patients per week that would turn up in clinics with the interstitial lung disease, but now the number has risen to 20-25 people/week in clinics.” “Most of them happen to be young housewives who spend most of their time indoors unaware of exposure to pigeon/birds through unserviced ACs,” followed by those with challenged immune systems, the elderly and the rest are those handling managing these birds.

Of late, pigeon feeding sites have emerged across Karachi and various other cities, where they are fed for a kind and noble act. Those employed to look after such sites often come down with this allergic reaction.

Explaining the progression of the disease, Prof Irfan said, “Exposure to droppings and proteinaceous material from the wings of pigeons, other fowl and birds provokes the disease producing an acute or chronic reaction.”

The very small proteins or allergens, ranging in size from 1-3 microns in diameter, released from flapping wings and bird droppings that lie deposited on the roofs, balconies, in cages, nests, at lofts near windows, travel indoors through windows, unserviced ACs to get lodged deep in the lungs.

Once lodged inside the alveoli, the minute air sacs inside the lungs trigger a severe allergic reaction. “From coughing to shortness of breath, which is often ignored by people in apartments as a result of exertion from climbing stairs, quickly descends to requiring urgent care at the hospital,” says Dr Irfan.

This progressive lung damage causes symptoms like breathing trouble, cough, tiredness, chest tightening and wheezing. “These symptoms may last for weeks or months and weight loss gets progressively worse.”

In medical nomenclature, Bird Fancier’s Lung (BFL) is a specific type of Hypersensitivity Pneumonitis (HP), which is an allergic reaction in the lungs. HP can become chronic, leading to ILD, which may lead to progressive and irreversible, lung fibrosis and scarring of lung tissue identified in CT exams and other tests.

Patients at this stage require long-term oxygen therapy and cardiopulmonary rehabilitation. For those in advanced stages lung transplantation remains the last treatment option, Prof Irfan said. This is not available at present in Pakistan and is only possible in India, China, UAE and other Western countries.

Dr Irfan said,” In early stages, it is completely curable. People need to immediately stop exposure to pigeons.” “As this immunological disorder spreads through the air, the only safety mechanism for patients and the healthy ones is to avoid exposure to pigeons,” he warned. However, “there is a caveat like any other affliction genetic predisposition also plays a role and some do not acquire the allergic reaction at all.”

It is critical that while cleaning the cages and lofts “they are washed” and not broomed and scrubbed to prevent their spread through the air. Wearing gloves and masks for managing the birds is another important layer of precaution. The doctor advised to keep away from the harm’s way.

Due to the serious nature of the disease, several countries have “outlawed” feeding these birds, particularly pigeons like Australia and Switzerland. Similarly the pigeon feeding site outside the Holy Ka’ba in Makkah has been removed following the KSA crisis with Covid-19 and Middle East Respiratory Syndrome (MERS).