Chronic Obstructive Pulmonary Disease and Alcohol: Is There a Link?

Chronic obstructive pulmonary disease is due to poorly reversible airflow obstruction, and alcohol consumption can exacerbate it. Learn more in this article.
Chronic Obstructive Pulmonary Disease and Alcohol: Is There a Link?

Last update: 20 November, 2021

In chronic obstructive pulmonary disease (COPD), there’s poor obstruction to airflow in the airways, making it difficult to move air out of the lungs. Although chronic alcohol consumption has not been shown to be a direct cause of chronic obstructive pulmonary disease, alcohol can play a role in worsening symptoms.

COPD causes shortness of breath, shortness of breath, and fatigue due to overworked respiratory muscles. Chronic cough and heavy sputum are also commonly present.

The diagnosis of chronic obstructive pulmonary disease begins with clinical suspicion and is complemented by spirometry. This test can reveal the non-reversible obstruction of airflow outflow from the lungs.

Causes and treatment for chronic obstructive pulmonary disease

COPD is classified into two main variants: chronic bronchitis and pulmonary emphysema. The diagnosis of the former is clinical and is defined as the presence of cough and expectoration on most days, for more than three months per year, for more than two consecutive years.

Pulmonary emphysema, on the other hand, is an anatomopathological diagnosis. It requires the demonstration of permanent enlargement of the alveolar walls, which imaging studies like chest X-rays can discover.

Espirometría para diagnóstico de EPOC.
Spirometry can be used to diagnose COPD.

The causes of chronic obstructive pulmonary disease

The typical cause of COPD is long-term exposure to airway irritants. The primarily recognized irritant is tobacco smoke, regardless of the form of use (cigarette, pipe, cigar, or water pipes).

Exposure to tobacco smoke is the cause of 85% of cases of chronic obstructive pulmonary disease.

However, exposure to other types of smoke may also be considered causes. These include:

  • Environmental pollution from biomass fuels.
  • Occupational exposure to dust particles, chemicals, wood, and gasoline.

In additional, some conditions are risk factors for chronic bronchitis or emphysema. These include the following:

  • Age: 65 years or older
  • Recurrent respiratory infections.
  • The presence of certain genetic factors, like alpha-1 antitrypsin deficiency
  • Current, past, or secondhand smoking
  • Having asthma


Treatment of COPD involves the use of drugs that dilate the airways (bronchodilators). Medicines that reduce inflammation and antibiotics are also prescribed when there’s an underlying or concurrent infection.

Pulmonary rehabilitation exercises are recommended for most patients. When the case is severe or has progressed too far, supplemental oxygen may be required.

Alcohol is not the cause of chronic obstructive pulmonary disease

Alcohol consumption is not a direct cause of chronic obstructive pulmonary disease. However, they’re indirectly related. Prolonged and excessive consumption of the substance tends to affect the immune system and the lungs, increasing the risk of developing the disease.

In addition, the association between chronic and excessive alcohol consumption and chronic tobacco use is common. Many people who smoke also drink alcohol.

Finally, alcohol can also interfere with the effectiveness of medications used. In particular, it does so with antibiotics and steroids.

How does chronic alcohol consumption affect the lungs and the immune system?

Alcohol affects the defense mechanism of the upper airways, modifies the alveoli wall, and causes dysfunction of the alveolar macrophages. Alveolar macrophages are the primary cells of the immune system in the lungs.

The mucociliary transport system is involved in defense of the upper airways. It’s responsible for clearing mucus and pollutant particles that enter the airways, removing them, and causing coughing to expel them.

However, alcohol paralyzes the cilia, which prevents the upper airway from clearing pathogens and irritants that enter. Thus, particles enter the alveolar space.

In the alveolus, irritants or pathogens would have to be removed by macrophages. However, in cases of chronic alcohol consumption and chronic obstructive pulmonary disease, macrophage activity is decreased. Thus, the responsiveness and clearance capacity fails. Susceptibility to types of pneumonia may then occur.

On the other hand, alcohol decreases the production of surfactants and modifies the permeability of the alveolar walls. This impacts the protective barrier and creates even more susceptibility to infection.

Infección en los pulmones con EPOC.
Infections in COPD patients who drink alcohol are more frequent because their immune system doesn’t respond adequately.

Macrophages and the immune system

Also, the presence of pathogens in the alveolar space activates oxidative pathways used by macrophages to eliminate pathogens. This results in the release of systemic inflammatory factors that increase oxidative stress and free radical release.

Finally, the proinflammatory state affects cellular barriers and decreases levels of the antioxidant glutathione. All of this combines to increase COPD symptoms in patients who consume alcohol and facilitate lung injuries.

Zero alcohol in chronic obstructive pulmonary disease

The main recommendation for COPD patients is to quit smoking and reduce their exposure to environmental tobacco smoke. However, the effect of alcohol should not be overlooked in making recommendations for people with chronic bronchitis or emphysema.

Chronic alcohol consumption is not a cause of COPD. Nevertheless, it does play a role in exacerbating the disease. Therefore, regular smokers with pulmonary risk factors or who already have COPD should eliminate alcohol from their diets.

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