Coughs And Colds: Is Beer A Friend Or Foe?

Alcohol is known to have adverse effects on the lungs and can cause or worsen respiratory problems such as asthma, tuberculosis, and pneumonia. It can also lead to dehydration and a weakened immune system, which may cause or worsen a cough. Additionally, certain ingredients in cough syrups, such as dextromethorphan or codeine, can have dangerous and even deadly interactions with alcohol. Therefore, it is generally advised to avoid consuming alcohol while taking any cough medication and when sick.

Alcohol and lung disease

Alcohol abuse can have a serious impact on multiple organs in the body, including the lungs. Alcoholic lung disease is an umbrella term for various diseases of the lungs caused by alcohol use. This term refers to the link between alcohol abuse and acute lung injury. Alcohol-related lung damage is most common among individuals who drink heavily or have been abusing alcohol for long periods.

Chronic alcohol ingestion impairs multiple critical cellular functions in the lung, leading to increased susceptibility to serious complications from a pre-existing lung disease. Alcohol abuse has long been recognised as a significant risk factor for pneumonia. Alcoholics have a higher risk of developing acute respiratory distress syndrome (ARDS) and experience higher rates of mortality from ARDS when compared to non-alcoholics.

Alcohol use can also negatively impact one's immune system, ultimately inhibiting the body from fighting off infection. This also increases the risk of bacteria spreading into the trachea and lungs. Alcohol is also linked to inflammation and impairment of users' gag reflexes, increasing the risk of pneumonia.

The mechanisms of alcoholic lung disease include:

• Metabolism of alcohol reduces glutathione antioxidant levels in the lungs.
• Oxidation damage to the cells impairs the ability of the lungs to remove fluid.
• Oxidative damage to cells reduces immune response.
• Oxidative damage to cells results in a reduced ability to recover from injury.

These chemical changes compound the negative mechanical and microbiological effects of alcoholism on the respiratory system. These include impaired gag reflex and cilia function and a greater likelihood of colonies of pneumococcal bacteria in the upper respiratory system.

Alcohol and asthma

Some people with asthma are sensitive to substances found in alcohol, called sulphites and histamines, which can trigger their asthma symptoms. Sulphites are used as preservatives in wine, beer, and cider production, while histamine is a chemical released during an allergic reaction, which is also found in many alcoholic drinks.

Wine (red and white) is the most common alcohol trigger for asthma symptoms, likely due to its higher levels of sulphites and histamines. Beer and cider can also trigger symptoms for some people. Clear spirits like gin and vodka contain lower levels of these substances but may still affect asthmatics. It is important to note that even non-alcoholic drinks like juices and fizzy drinks, which are sometimes mixed with alcohol, can contain sulphites and histamines.

Reactions to alcohol vary among individuals with asthma. Some people notice symptoms after a few sips, while others can have one or two drinks without problems. Additionally, alcohol may increase sensitivity to other asthma triggers like cigarette smoke and pollen. It is essential for people with asthma to be aware of their personal triggers and take necessary precautions.

According to the NHS, it is usually safe to drink alcohol while using preventer and reliever inhalers. However, it is advisable to avoid alcohol when taking steroid tablets as it can irritate the stomach. It is always recommended to consult a healthcare professional, such as a GP, nurse, or pharmacist, for personalised advice regarding drinking alcohol while taking medications.

Lowering the Risk of Asthma Symptoms from Alcohol

• Choose your alcohol wisely or avoid it altogether: If specific alcoholic drinks trigger your asthma, try avoiding them or opting for non-alcoholic alternatives. Low-sulphite wines are also available, but remember that they still contain some sulphites.
• Don't skip your preventer medicine: Using a preventer inhaler or a MART inhaler daily as prescribed can help protect against asthma triggers by reducing inflammation and swelling in the airways.
• Share your asthma action plan: An up-to-date asthma action plan can inform friends and family about your condition, allowing them to recognise when you need your reliever inhaler and how they can help.
• Have your annual asthma review: Annual asthma reviews provide an opportunity to discuss any triggers and symptoms noticed, including the impact of alcoholic drinks.
• Talk to teenagers with asthma about alcohol risks: If there are teenagers with asthma at home, educate them about the potential risks of alcohol triggering their asthma symptoms, especially as they navigate new social situations like festivals or college.

While the connection between alcohol and asthma is not yet fully understood, asthmatics should be cautious when consuming alcohol and be aware of their personal triggers. The best way to determine if alcohol is an asthma trigger is to monitor symptoms when drinking. It is also important to follow general NHS guidelines for alcohol consumption to reduce associated health risks.

Alcohol and dehydration

Alcohol's Diuretic Effects

It is a common belief that alcohol causes dehydration. However, this is a myth. While alcohol is a diuretic—meaning it makes you urinate more—the additional urine output due to alcohol consumption is not significant enough to cause dehydration. Research shows that drinking an initial amount of alcohol will make you urinate more than if you drank the same amount of water. However, continuing to drink alcohol after that initial drink does not cause a significant increase in urine output compared to drinking water.

Alcohol's Other Effects on the Body

Despite alcohol's lack of dehydrating effects, it is still best to avoid it when sick, as it can worsen symptoms and weaken the immune system. Alcohol affects the body in numerous ways, including:

• Interrupting sleep by affecting GABA and glutamate signalling in the brain
• Irritating the gastrointestinal (GI) tract and causing inflammation
• Altering the balance of the microbiome, potentially leading to bloating and gut and systemic inflammation
• Inhibiting the antidiuretic hormone vasopressin, which leads to a small increase in urination and wider hormonal imbalances

Acetaldehyde's Effects on the Body

Acetaldehyde is a metabolic byproduct of alcohol consumption and is highly toxic. Its effects on the body include:

• Causing vasodilation, which can lead to a flushed face and feeling hot
• Causing cell death and DNA damage, resulting in runaway inflammation
• Binding to receptors in the brain, creating oxidative stress, and causing nausea, vomiting, tremors, dizziness, diarrhoea, and malaise

Alcohol and immune system suppression

Alcohol has a detrimental impact on the immune system, leaving the body vulnerable to infections and diseases. The immune system is made up of two parts: the innate immune system, which provides general immunity by responding to viruses, bacteria, and other microorganisms that can cause disease; and the adaptive immune system, which includes immune memory, such as recognising previous infections and preventing them from reoccurring. Drinking alcohol negatively impacts both parts of the immune system.

Even drinking 5-6 drinks in a single session can suppress the immune system for up to 24 hours. Over time, drinking can lead to longer-term problems as the immune system takes longer to recognise and respond to infections. This results in more intense illnesses, longer-lasting symptoms, and the immune system having to work harder to fight off infections.

The lungs are particularly vulnerable to the effects of alcohol. Excessive drinking impacts the immune cells that protect the lungs and the cells within the airways, reducing their ability to remove mucus. This can damage the lung tissue and lead to a weakening of lung function over time. This weakening often goes unnoticed until a severe infection occurs. Heavy drinking can result in a 3-7 times higher vulnerability to serious conditions, like pneumonia, developing from common respiratory tract infections.

Alcohol also impacts the gut by influencing the number and variety of 'good' bacteria in the gastrointestinal (GI) tract, which is necessary for healthy immune function. The cells that make up the lining of the GI tract regulate what is absorbed into the body, and alcohol impacts these cells, contributing to the development of alcohol liver disease.

Alcohol and choking/aspiration pneumonia

Alcohol abuse has been associated with a two- to nine-fold higher risk of pneumonia. While the dose-response relationship between alcohol consumption and pneumonia risk in healthy individuals is poorly understood, it is known that alcohol overuse can increase the risk of aspiration and suppress the normal cough reflex.

Heavy alcohol intake has been known for centuries to impair lung defences. Alcohol intake is also clearly linked to a variety of airway diseases, likely playing pathogenic, treatment, and protective roles. For example, alcohol has been used as a treatment for asthma since antiquity, but it can also trigger asthma attacks.

The volatility of alcohol promotes the movement of alcohol from the bronchial circulation across the airway epithelium and into the conducting airways of the lung. The exposure of the airways through this route likely accounts for many of the biological effects of alcohol on lung airway functions. The impact of alcohol on lung airway functions is dependent on the concentration, duration, and route of exposure. Brief exposure to mild concentrations of alcohol may enhance mucociliary clearance, stimulate bronchodilation, and probably attenuate the airway inflammation and injury observed in asthma and chronic obstructive pulmonary disease (COPD).

On the other hand, prolonged and heavy exposure to alcohol impairs mucociliary clearance, may complicate asthma management, and likely worsens outcomes, including lung function and mortality in COPD patients. Non-alcohol congeners and alcohol metabolites act as triggers for airway disease exacerbations, especially in atopic asthmatics and in Asian populations who have a reduced capacity to metabolize alcohol.

In conclusion, moderate alcohol intake does not appear to have a detrimental effect on pneumonia risk. However, heavy alcohol consumption is associated with a higher risk of pneumonia-related hospitalisation.

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