Treating Alcohol Use Disorder May Help Reduce Disease Burden in Asthma and COPD

More than 95,000 people in the U.S. die of alcohol-related causes each year, reports the Centers for Disease Control and Prevention. That number is likely underestimated, suggests Joe Zein, MD, PhD, MBA, a pulmonologist in Cleveland Clinic’s Respiratory Institute.

“We know the direct impact of alcohol use disorder, but we don’t know the indirect impact on other diseases,” he says. “Excessive alcohol use can cause liver failure. It can blunt immune response and lead to malnutrition. But how does it affect outcomes in asthma, for example? The indirect burden of alcohol and substance use is equally important to our healthcare system and to society.”

A study recently published in Alcohol explored the relationship.

More respiratory failure, longer hospital stays

Dr. Zein and a research team analyzed the records of more than 2 million patients with asthma or chronic obstructive pulmonary disease (COPD) in the Nationwide Emergency Department Sample and 1.1 million in the 2012-2015 Nationwide Readmissions Database. They found that patients with alcohol use disorder were more likely to:

• Present with respiratory failure
• Require mechanical ventilation in the emergency department (ED)
• Have a 5% longer length of stay when hospitalized
• Have higher hospitalization costs
• Be readmitted for asthma or COPD within 30 days

“These findings really weren’t surprising,” says Dr. Zein. “The effects of alcohol, which can include higher risk of aspiration, infection and muscle wasting, can affect respiratory function and endurance, making respiratory failure more likely.”

The study is the first to draw the distinct correlation between alcohol use disorder and adverse outcomes in asthma and COPD. It echoes the research team’s 2020 study, published in the Journal of Asthma, which linked illegal drug use in the same cohort with higher healthcare use and cost.

“The increase in disease morbidity persists even after adjusting for the effects of alcohol or substance misuse and related comorbidities,” says Dr. Zein.

What it means for pulmonologists

This study may prompt more pulmonologists to ask about alcohol use and illicit drug use when managing patients with asthma or COPD, and potentially other respiratory diseases.

Alcohol use isn’t an issue only for primary care, emphasizes Dr. Zein. If a primary care provider has already discussed reducing alcohol for the patient’s overall health, a pulmonologist can encourage reducing alcohol specifically to decrease the burden of respiratory disease.

“We’ve been focused on reducing the cost and burden of asthma and COPD with better medication, better education and better follow-ups,” he says. “Now we have another method: treating alcohol use disorder.”