Emphysema And Alcohol

What is emphysema?

Emphysema is one of the diseases classified as Chronic obstructive pulmonary disease (COPD). It is a disease of the respiratory system that results from damage to the air sacs of the lungs, called the alveoli. The alveoli expand during inhalation to contain the air and then contract to empty the oxygen to the blood for circulation and take up carbon dioxide for exhalation. Cigarette smoking leads to the influx of inflammatory cells which results in the inflammation of the lungs and consequent damage. Hence, lung injury in emphysema is a result of inflammatory and destructive processes in response to smoking.

Emphysema development comes as a result of alveolar septal death.¹ The inflammatory cells (neutrophils and macrophages) increase both during the disease initiation processes and exacerbations and hence find their way into the lungs to cause damage. Reactive oxygen and nitrogen species release have also been implicated with smoking. These agents cause oxidative cell damage to the alveoli. Hence, the walls of the alveoli get damaged through inflammation from increased release of inflammatory cells, oxidative damage by free radicals, and also through cell death which comes from either apoptosis (programmed cell death), autophagy (recycling of cell components), and necrosis. One or a combination of the above results in emphysema as a result of loss of alveoli surface and function. When this occurs, air that ordinarily should have been pushed into the bloodstream gets trapped in the air sacs resulting in the symptoms of emphysema. Therefore, emphysema is a chronic disease of the lungs where the air gets trapped in the air sacs leading to  such symptoms as shortness of breath, wheezing and so on.¹

Symptoms

The symptoms of emphysema are:

• Shortness of breath
• Fatigue
• Overproduction of mucus
• Chronic cough
• Wheezing
• Gasping for air

The effect of alcohol on the lungs

Alcohol use causes a lot of diseases like liver damage, pancreatitis, heart damage, muscle damage, and even dementia. Alcohol use by people with Alcohol use disorder (AUD), has been established to cause some form of lung damage through the disruption of the immune cells that protect the lungs like alveolar macrophages, neutrophils, and B cells. This, therefore, increases the susceptibility of the lung to come down with such diseases as pneumonia, tuberculosis, Respiratory Syncytial Virus (RSV), Acute Respiratory Distress Syndrome (ARDS), and emphysema.

This effect of alcohol on lung cells had often been neglected by clinicians. Pneumococcal pneumonia caused by Streptococcus pneumoniae is a leading form of pneumonia seen in both alcoholics and non-drinkers. However, pneumonia of Klebsiella origin is common amongst the people who take alcohol and hence results in increased lung infection amongst the people of this population. Alcohol consumption disrupts the immune system's protection, results in oxidative damage to the cells, and leads to damage to the antioxidants like vitamin A, vitamin E, and glutathione.²

Alcohol lowers glutathione levels

Glutathione is an antioxidant that is produced endogenously in the body. It protects the lungs against oxidative damage. Lung damage as earlier stated comes from the imbalance between the oxidants/antioxidants, inflammation, and cell death, hence, with the decrease in glutathione levels by consumption of alcohol, the oxidative damage of the lungs increases. Glutathione (GSH), a tripeptide thiol, plays a vital role in the regulation of pro-inflammation processes.

Recent studies have also shown that GSH plays a role in immune modulation, extracellular matrix remodelling, apoptosis, and cellular respiration. Alcohol reduces the level of GSH and other antioxidants thereby exposing the alveoli cells to the risk of oxidative damage and hence, emphysema.³

Alcoholic lung

Alcohol, apart from being the leading cause of pneumonia, is a major cause of acute lung injury which results in a three to fourfold increase in ARDS, hence resulting in up to 40-50% mortality rate from lung injury. Alcohol causes damage that is comparable to the same kind of damage it does to the liver (scarring of the liver termed liver cirrhosis). The alcoholic lung is a state of the lung of alcohol users that may predispose the lung to an increased risk of acute disease following a physical trauma like an accident or bacterial infection. The alcoholic lung is marked by serious oxidative stress which may not necessarily cause pronounced damage or impairment to the lung but would aid or facilitate the damage of the lung when other factors like accidents, or bacterial or viral infections hit the lung. Hence, alcoholic lungs become susceptible to lung damage and malfunction following future exposure to things that would result in lung disease.⁴

Alcohol and emphysema medication

Theophylline

This is a bronchodilator used for treating asthma, bronchitis, and emphysema. When taken with alcohol, muscle pain was found as a result of the interaction.⁵

Salmeterol

This is a beta-2 adrenergic agonist used in the treatment of asthma, emphysema, and other lung diseases. It is important to note that alcohol should not be mixed with salmeterol as this could trigger an asthma attack or increase your heart rate or tachycardia.⁶

Roflumilast

A phosphodiesterase 4 inhibitor for the treatment of bronchitis and COPD.

Revefenacin

An anticholinergic drug used for the supportive treatment of people with chronic lung disease. It is an inhalational therapy.

Formoterol

This is a long-acting bronchodilator for the treatment of people with COPD. Combined with alcohol, this may cause high blood pressure.⁷

Fluticasone

This is a glucocorticoid for the treatment of people with asthma and COPD.

Budesonide

This is a corticosteroid prescribed for inflammatory bowel disease and for people with respiratory disease.

Salbutamol and ipratropium combination

Are prescribed for the treatment of wheezing, difficulty breathing, chest tightness, and coughing resulting from COPD.

If you’re worried about your or your loved one’s alcohol intake

Alcohol intake does not only affect the liver,  the heart, the brain, and the muscle cells but also the lungs and hence increases the risk of getting COPD.

Summary

Emphysema is the trapping of air in the air sacs of the lungs otherwise called the alveoli. The alveoli can get damaged by smoking cigarettes or drinking alcohol. These agents affect the oxidative/antioxidative agents balance thereby resulting in oxidative damage to the alveoli cells. Alcohol leads to the depletion of glutathione levels and hence reduces its antioxidant activity which would lead to cell damage. There is also an increased risk of inflammatory damage as a result of the release of inflammatory factors by alcohol and smoke. The combined effect of oxidative damage, inflammation of the tissues, and cell deaths result in the damage of the alveoli and hence makes them susceptible to diseases when an accident or any other form of trauma is encountered, and infections. Emphysema is characterised by wheezing, chest tightness, laboured breathing, and severe cough. Constant consumption of alcohol results in what is termed an alcoholic lung with the lung being more prone to potential damage through physical trauma or microbial infection. Treatment of emphysema is with different classes of drugs that improve the circulation of air in the airways like bronchodilators and antiadrenergic agents.