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case study

Icelandic farmers clear ash following a heavy downpour from the Eyjafjallajokull volcano this week.

"Doc, I miss my volcano."

"You miss your what?" I said.

"My volcano. Honestly, I miss it," said Roderigo, 38, recently arrived in Canada from Mexico.

After weeks of tests and X-rays, we had finally discovered the cause of Roderigo's severe lung disease. While European airports suffer from continued closings, delays and safety concerns because of Iceland's stubborn volcano, doctors know that volcanic ash can compromise health. Like jet engines, people can also be grounded by inhaling the dangerous dust, suffer long-term disability or even crash.

For months, Roderigo's breathing was worsening. At first, it seemed to be a standard case of asthma, with occasional breathing tightness, wheezing and phlegm in the chest. He seemed to do well after being prescribed the usual asthma inhalers. He even got rid of his girlfriend's cat, as cat hair and dander are universal evils in the eyes of asthma doctors.

But after a bad bout of fever, coughing and gasping for air, we did a chest X-ray. The results were astonishing. His lungs looked like he had unrepentantly smoked a pack a day for 40 years - older than his age. Yet Roderigo swore he was an absolute non-smoker. He said, "Doc, I don't smoke, legal or illegal."

Roderigo did not have asthma but something more challenging. He had severe emphysema, which doctors usually see in dedicated smokers twice Roderigo's age. His lungs had been trashed, resembling the burnt out shells of a bombed city. Much of his lungs were just dead tissue, useless for inhaling oxygen. In fact, his entire chest was a war zone.

What had caused so much damage? Searching for an inhaled culprit, physicians remember the days of medical school. I asked default questions from vaguely remembered lectures. Did you work in a coal mine? Chemical industry? Did you inhale fungus while working on a farm? Did you ever have tuberculosis? Roderigo answered "no" to all these questions and assured me that he was not indulging a cocaine or other drug habit.

Then after thinking, Roderigo said, "There is Popocatepetl."

"Pardon me?" I replied.

"Popocatepetl. My volcano. My family lived on its slopes outside Mexico City. As kids we had songs and games to guess when it would smoke. That's why I miss it."

I thought I had a reasonably international view of medical illness but Roderigo's case was remarkable. From childhood he had been inhaling small amounts of ash emitted by the recurring eruptions of his beloved volcano, Popocatepetl, which means "smoking mountain" in Aztec.

European travellers are discovering now what Roderigo has lived all his life. Inhaling glass-like silica particles of volcanic ash damages machinery, including the body. As more dust particles settle in the lung, the body goes on the offensive. But the particles are not biodegradable. Unwanted guests, they lodge in the lungs like permanent stalactites in a cave. In vain, the body recruits police cells to do mop-up exercises to cleanse the lungs. But this friendly fire, the immune response, goes into overdrive and leads to collateral damage. The lungs become chronically irritated and angry, and they harden and scar, a process called fibrosis.

With the Industrial Revolution, there were more and more such cases, what came to be known as pneumoconiosis, "dusty lungs." Delamar, a city in Nevada famous for its mines, became known as "the Widow Maker" after hundreds of miners died from years of inhaling gold dust.

Canadian physicians may encounter this disease in patients who work in the asbestos industry, sandblasting, stone masonry or mining. But Roderigo's rare case reminds us of how large and subtle the world actually is. In fact, the official name for his specific condition is as long as the flight delays in Europe. Take a deep breath: Roderigo has Pneumonoultramicroscopicsilicovolcanoconiosis.

Dr. Shafiq Qaadri is a Toronto family physician. Special to The Globe and Mail