Academic journal article Alcohol Research

Alcohol and the Lung

Academic journal article Alcohol Research

Alcohol and the Lung

Article excerpt

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 18 th 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 Osler 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. 2003). Other investigators have confirmed these associations (Iribarren et al. 2000; Licker et al. 2003; Spies et al. 1996; von Heymann et al. 2002). Taken together, all of these findings indicate that drinking patterns that define AUD are associated with a significantly increased risk of serious lung infections and acute lung injury and thereby contribute to the deaths of tens of thousands of Americans every year, and many more worldwide.

This review first will discuss key aspects of the epidemiology and pathophysiology of AUD and lung health, before focusing more in-depth on lung infections and acute lung injury, which comprise the majority of alcohol-related lung diseases. The article also will briefly review some of the experimental therapies that hold promise for decreasing the enormous morbidity and mortality caused by the "alcoholic lung" in our society.

Alcohol and the Airways

The potential influence of alcohol consumption on airway health and disease has been documented for a long time. …

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