Academic journal article Alcohol Research: Current Reviews

Alcohol and the Lung

Academic journal article Alcohol Research: Current Reviews

Alcohol and the Lung

Article excerpt

Among the many organ systems affected by harmful alcohol use, the lungs are particularly susceptible to infections and injury. The mechanisms responsible for rendering people with alcohol use disorder (AUD) vulnerable to lung damage include alterations in host defenses of the upper and lower airways, disruption of alveolar epithelial barrier integrity, and alveolar macrophage immune dysfunction. Collectively, these derangements encompass what has been termed the "alcoholic lung" phenotype. Alcohol-related reductions in antioxidant levels also may contribute to lung disease in people with underlying AUD. In addition, researchers have identified several regulatory molecules that may play crucial roles in the alcohol-induced disease processes. Although there currently are no approved therapies to combat the detrimental effects of chronic alcohol consumption on the respiratory system, these molecules may be potential therapeutic targets to guide future investigation.

Key words: Alcohol consumption; alcohol use disorder; alcoholic lung; lung; lung disease; lung Injury; respiratory system; pulmonary system; alveolar macrophage; antioxidant

Few social practices have had a longer or more complicated history in human civilization than the consumption of alcohol. As documented in academic writings, but even more commonly in art and music, humans have consumed alcohol for thousands of years, and drinking is either a celebrated facet of social activities or a proscribed practice, depending on the local moral or religious views. Although alcohol intoxication has been described in various written recordings since antiquity, it is only relatively recently that its true effects on lung health have been recognized. In the latter years of the 18th century, the first Surgeon General of the United States of America, Benjamin Rush (for whom the medical school in Chicago is named), noted that excessive alcohol consumption was associated with pneumonia (see Happel and Nelson 2005; Mehta and Guidot 2012). More than a century later, William Osier wrote that alcohol abuse was the most important risk factor for pneumonia (see Happel and Nelson 2005; Mehta and Guidot 2012). As modern medicine evolved throughout the 20th century, it became abundantly clear that alcohol use disorder (AUD) rendered people more susceptible to a wide variety of lung infections, including bacterial pneumonias and tuberculosis, and increased morbidity and mortality. In a now-classic modern citation, Perlino and Rimland (1985) coined the term "alcoholic leukopenic pneumococcal sepsis syndrome" when they published a case series of patients with underlying AUD who suffered from pneumococcal pneumonia and sepsis associated with leukopenia that was associated with a mortality of more than 80 percent. Excessive alcohol consumption seems to increase susceptibility to pneumonia through multiple mechanisms. The major factors include an increased risk of aspiration, abnormalities in the way particles are eliminated from the conducting airways through the mucus (i.e., in mucociliary clearance), and impaired activity of one branch of the immune system (i.e., innate immunity) within the lower airways (for reviews, see Joshi and Guidot 2007; Mehta and Guidot 2012).

Even more recently, researchers have identified an association between underlying AUD and acute respiratory distress syndrome (ARDS). ARDS is a severe form of acute lung injury that occurs as a complication of diverse insults, including sepsis, massive aspiration, and trauma; it has a mortality rate of 30 percent to 50 percent, even with state-of-the-art modern medical care in an intensive care unit (Villar et al. 2011; Wang et al. 2014; Ware 2006; Ware and Matthay 2000). In 1996, a seminal study demonstrated for the first time that AUD independently conferred an approximately twofold increase in risk of developing ARDS (Moss et al. 1996). A subsequent prospective study focusing only on patients with severe sepsis revealed that the relative risk of developing ARDS was closer to fourfold higher in those with an underlying AUD; (1) this effect was independent of factors such as age, smoking, severity of illness, and nutritional status (Moss et al. …

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