How Does Alcohol Affect the Lungs

We’ve all heard of smoker’s lung — that characteristic hacking, wheezing cough that’s enough to scare many of us from ever trying a cigarette. But a drinker’s cough? Is that a thing? If you wake up with a nagging cough that doesn’t seem to ease up and gets more persistent over time, that glass (or bottle) of Chardonnay you’ve been downing on a regular basis probably won’t be your first suspect. And yet, “alcoholic cough,” shortness of breath after drinking alcohol, and even signs of lung failure can all be signs of alcoholic lung disease. Let’s explore this lesser-known respiratory problem in more detail.

Can Alcohol Cause Breathing Problems?

It’s no secret that alcohol harms many systems of the body. It wreaks havoc on the liver, crosses the blood-brain barrier, suppresses neural activity, and even disrupts our sleep. But what about breathing?

As it turns out, alcohol has both direct and indirect effects on our lungs. Let’s explore the direct ones first.

The Lungs: A Brief Tour

Our lungs are about as advanced as any piece of fancy technology. Here’s how they work.

According to the National Heart, Lung, and Blood Institute, the lungs are a “pair of spongy, pinkish-gray organs in [our] chest.” Acting as the “centerpiece of [our] respiratory system,” they filter incoming air, delivering oxygen to the blood and removing carbon dioxide with each exhale. Inside the lungs, tubes known as bronchi that carry the air in branch off into smaller bronchioles, which are topped off by tiny air sacs called alveoli. It's in these microscopic alveoli that the magic of gas exchange happens.

The alveoli are tiny, balloon-like structures surrounded by a network of capillaries. These capillaries are so small that blood cells have to pass through them in a single file. When air reaches the alveoli, oxygen from the air passes through their thin walls and into the blood in the capillaries. At the same time, carbon dioxide, a waste product of metabolism, moves from the blood into the alveoli. This gas exchange process is crucial to life: as all of us who tried to hold our breath underwater know, it’s a matter of minutes before we desperately need air.

In addition to the lungs, the respiratory system includes the trachea (or windpipe), chest wall and diaphragm muscles, blood vessels, and more. Our brain is the central hub in charge of regulating breathing rates by keeping tabs on oxygen and carbon dioxide levels in our body.

Alcohol and the Lungs

Alcohol wreaks havoc on the body, and the lungs are no exception. Emory University pulmonologist David Guidot has made it his life’s work to study the effects of AUD on the lungs. As he explains in an Emory Medicine press release, “The lungs are especially vulnerable because chronic drinking depletes them of glutathione, and the alveoli and small airways are very dependent on it. Normally, they have 1,000 times more glutathione than other parts of the body. Chronic alcoholics have extremely low levels of glutathione in the lungs.” While the alcohol itself isn’t the direct cause of the changes, the oxidative stress that it causes leads to glutathione depletion.

Why is glutathione important? It’s an antioxidant that plays a vital role in keeping the lungs healthy and free from harmful substances. It also helps create and maintain T-cells, which are vital for immune function.

The Long-Term Respiratory Effects of Drinking

Chronic alcohol abuse and the glutathione depletion that happens as a result can damage the cells lining the respiratory tract, leading to a condition known as acute respiratory distress syndrome (ARDS). This severe form of lung failure can be life-threatening and happens when chronic inflammation leads fluids and inflammatory cells to accumulate in the alveolar spaces. The result? Our airways get clogged, making gas exchange less efficient. 

Over time, the lack of oxygen can take a toll on our health. If not addressed in time, it can lead to organ failure and other life-threatening complications. Other factors might make the situation worse: for example, infections, injuries, or breathing in stomach contents (something that can happen in severe intoxication) can all play a role.

The Link Between AUD and ARDS

The connection between ARDS and alcohol was first discovered in 1996 by a University of Colorado team led by Marc Moss. With the help of some lab rats who “drank for science” and demonstrated the link between alcohol and glutathione levels, Moss and his colleagues were able to see just how drastic the effect of booze on our lungs is. 

Today, scientists like Emory’s Guidot and his colleagues continue to uncover new details of what’s often referred to as “alcoholic lung disease.” One of his studies tracked alcoholic patients in hospitals around Atlanta, Denver, and Seattle who were admitted for various reasons, including septic shock and blood pressure problems. Guidot and his team found that the correlation between AUD and ARDS was even higher than previously thought. As Guidot explains, “We followed the alcoholic patients to see how many developed ARDS, and it turned out that the relative risk of ARDS for those with alcohol abuse was closer to 4 to 1 than the 2 to 1 risk that was identified in the original 1996 study … The results were dramatic.”

Another recent study is relevant to an even wider audience and is certainly food for thought when it comes to evaluating our drinking habits. Guidot and his team looked at the effect of alcohol on glutathione levels in “relatively functional alcoholics” — young folks who were treated for AUD in an inpatient facility, but were otherwise medically stable, healthy, and well-nourished. They found that glutathione levels in the lungs of the subjects were 80% to 90% lower compared with their non-drinking counterparts at the 2-3 day mark after their last drink and remained low for at least a week. 

An Indirect Attack: Alcohol and Respiratory Infections

In addition to messing with their ability to deliver oxygen to the cells of our body, alcohol interferes with another important function of the lungs — their role in the immune system. The respiratory tract is lined with cilia, tiny hair-like structures that help keep the airways clean by sweeping our pathogens and harmful particles along with mucus. 

Alcohol can impair the function of these tiny sweepers, making us more susceptible to diseases — especially those that target the lungs in particular, such as pneumonia or tuberculosis. The result? An indirect (albeit equally devastating) attack on the lungs.

For a closer look at other effects of alcohol on the immune system, check out our blog, “Alcohol's Impact on the Immune System.”

Alcoholic Pneumonia

Bacterial pneumonia, also known as “alcoholic pneumonia” (when related to AUD), is one of the most common and serious complications. According to the NIH, pneumonia is an inflammation of the lung caused by infection by bacteria. That said, it can also be caused by fungi, viruses, and parasites. The name itself comes from the Greek “pneumon” (meaning lung), underscoring pneumonia’s prominence as the classic “lung disease.” 

Pneumonia can be serious (especially for sensitive populations), and with alcohol in the picture, things get even more gnarly. The first link between alcohol abuse and pneumonia dates back over two centuries when Surgeon General Benjamin Rush described the link between the two. Today, the CDC is still on board with Rush, describing pneumonia as being four times more likely to be deadly to people who abuse alcohol.

Tuberculosis and AUD

In addition to bacterial pneumonia, lung infections with Mycobacterium tuberculosis (the pathogen that causes TB) are also a particular threat for people with AUD. According to the WHO, TB is the second leading cause of death around the world, taking over a million lives every year. Spread through the air from one infected person to another, it often remains dormant and doesn’t necessarily make everyone who contracts it sick. That said, those with a compromised immune system — including one weakened by alcohol — are more likely to develop serious symptoms. 

RSV and AUD

While bacterial infections tend to be in the spotlight when it comes to alcohol-related lung complications, viral infections are also a concern. RSV is a common viral infection that affects the lower part of the respiratory tract and is very common in children, older people, and folks with AUD. Because alcohol affects the cilia that act as the “first line” defense force against invading pathogens, RSV has an easier way into the respiratory tract.

Signs of Alcoholic Lung Disease

Now that we know a bit about what we’re dealing with, let’s take a look at the signs to look out for if we suspect alcoholic lung disease might be a problem. Most of these signs are more relevant to ARDS, but some could be symptoms of respiratory infections that result from an immune system weakened by alcohol:

• Shortness of breath. We might have trouble breathing, especially during exercise or activities that require exertion, like climbing the stairs. While shortness of breath can be a sign of many things (after all, who hasn’t gotten a bit winded climbing up several flights when the elevator is broken), any changes from the norm could be a sign of a problem. If we’ve been drinking a lot, it’s not a symptom we want to ignore, since it could be one of the early signs of alcoholic lung disease.
• Chronic cough and wheezing. If we keep coughing for days or weeks, it could be another sign our drinking is interfering with our lung function. The “alcoholic cough” might be dry or could produce phlegm. A wheezing sound could be a sign of obstruction or narrowing of the air passages in the lungs.
• Weakness and fatigue. If we’re feeling more tired than usual, compromised lung function might be to blame. Our body and brain might not be getting the oxygen needed to function properly.
• Changes in weight. If we see that scale going down without changing anything in our habits, it might initially come as a pleasant surprise. Not so fast! Unintended weight loss is cause for concern and could be a sign of chronic lung disease related to alcohol use. 
• Pain in the chest. Severe lung conditions or infections could get painful and definitely warrant a trip to the doctor.
• Frequent infections. As our lung condition progresses, we could find ourselves getting frequent infections, especially ones that affect the respiratory system.

As with all serious conditions, signs of alcoholic lung disease are not something to take lightly. If you suspect you’re having symptoms, it’s always best to get checked out as early as possible.

Can “Alcohol Lung” Be Reversed?

It depends. If caught early enough, sometimes the damage can be reversed. In other cases, the damage might be quite extensive — however, treatment will still make a difference, so it’s crucial to seek medical help.

If we’re talking about acute respiratory conditions that were worsened by alcohol (such as pneumonia), recovery is usually possible as long as treatment is prompt. It includes a few key steps:

• Stop drinking to let our immune system recover.
• Take medication (usually antibiotics) as prescribed. If necessary, we may be put on a ventilator to help with breathing issues.
• Receive appropriate aftercare and rehabilitation.

If our condition is chronic or we’ve had repeated bouts of ARDS, the damage might be hard to reverse completely. Still, quitting or cutting back on alcohol and receiving proper medical care can help us manage our symptoms or slow their progression.

The common denominator in all of these cases is changing our relationship with alcohol. Especially if it has landed us in the hospital with a serious infection, it’s time to reassess things. (If that’s you, stay positive — many people have been where you are and have found a way out, and you can, too! Reframe is here to help you every step of the way.)

Tips To Breathe Easy and Stay Safe

As for some general ways to keep respiratory issues at bay, here are some handy tips:

1. Load up on antioxidants. Many plant foods, such as fruits and vegetables, are great sources of antioxidants that can help keep your lungs healthy. Leeks, onions, and garlic are great sources of allium sulfur compounds. Eggplant, grapes, and berries contain anthocyanins. Apples, onions, and citrus fruits are loaded with flavonoids. 
2. Make exercise a habit. One of the best ways to increase lung capacity? Aerobic exercise. Whether you walk, jog, swim, or dance in your living room, pick an activity you enjoy and stick with it.
3. Don’t smoke. Those scary pictures and warnings on cigarette boxes are true. According to the CDC, “More than 16 million Americans are living with a disease caused by smoking. For every person who dies because of smoking, at least 30 people live with a serious smoking-related illness.” These illnesses include cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), as well as emphysema and chronic bronchitis. 
   
   Secondhand smoke is a known culprit, too, and contributes to around “41,000 deaths among nonsmoking adults and 400 deaths in infants each year.”
4. Steer clear of outdoor pollutants. Keep tabs on air quality alerts on your watch, phone, or online. If your area is in the danger zone, limit outdoor time and opt for indoor exercise options. Also, try not to jog near high-traffic areas and avoid burning wood or trash in your backyard (or anywhere else, for that matter).
5. Avoid indoor air pollutants. We sometimes forget about indoor air quality, but it matters! After all, most of us spend a good chunk of the day indoors. Stay safe by sticking to no-smoking policies indoors, avoid using harsh chemicals, and invest in an air purifier if you are sensitive to pollutants.

With these tips, you can keep respiratory issues at bay and breathe easier as your lung function improves. And if you need extra support to change your relationship with alcohol to make sure your lungs stay as healthy as possible for years to come, Reframe is here to help!