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Doctors warn of ‘feather duvet lung’

Patients should be alert for respiratory problems on switching to feather bedding

Mark Gould

Tuesday, 19 November 2019

Doctors writing* in BMJ Case Reports have reported a case of “feather duvet lung” – an inflammation caused by breathing in dust from the feathers in bedding.

They say clinicians should be alert if patients turn up with unexplained breathlessness.

The team say the condition, a form of hypersensitivity pneumonitis, is down to an immune response. Symptoms include night sweats, a dry cough and shortness of breath – repeated exposure to the cause can cause irreversible scarring of the lungs.

Consultant chest physician Dr Owen Dempsey, from the Aberdeen Royal Infirmary and colleagues from Victoria hospital in Kirkcaldy, describe how a 43-year-old non-smoking man went to his GP after experiencing three months of malaise , breathlessness, and fatigue.

Lung function testing confirmed a restrictive pattern with impaired gas transfer. A “ground glass” mosaic pattern was seen on CT imaging, suggestive of hypersensitivity pneumonitis. Although he had no pet birds, on closer questioning he told doctors that he had recently acquired a duvet and pillows containing feathers.

The man was advised to ditch the bedding, check his chimney and loft for birds and make sure any mould in the house was treated.

Within a month of shedding the feather bedding, the man showed clear improvements and, with a subsequent course of oral corticosteroid therapy, felt completely well after six months.

Subsequent tests showed the man had unusually high avian precipitins. In addition, further scans showed a pattern in the lungs that hinted at hypersensitivity pneumonitis, while his lung function was significantly impaired.

“Healthcare professionals are typically taught to ask patients with respiratory symptoms whether they have pets at home, such as birds, but in the authors’ experience, history-taking does not usually extend to asking about feather exposure in duvets and pillows,” Dr Dempsey and colleagues write. “This is an important omission since the use of feather, rather than synthetic, bedding is common.”

While hypersensitivity pneumonitis appeared to be rare, and the report only covered one case of feather duvet lung, many cases could go unnoticed.

“I suspect it is the tip of an iceberg,” Dr Dempsey said. “I think there are lots of exposures out there that we are not aware of, and just because we are not aware of them they get ignored.”

*Liu-Shiu-Cheong P, Kuo CR, Wilkie SW, et al. Feather duvet lung. BMJ Case Reports CP 2019;12:e231237.

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