Alcohol abuse: Weighing the risks of pneumonia and ARDS

Although it has been known for at least a century that alcohol abuse is a risk factor for pneumonia, it has only recently been shown to be an independent risk factor for the acute respiratory distress syndrome (ARDS). In fact, alcohol abuse more than doubles the risk of ARDS in critically ill patients. Moreover, there is strong evidence that alcohol abuse increases the risk of pneumonia and ARDS even in persons who are otherwise healthy. A number of factors contribute to this increased risk; in addition to the well-known role of aspiration in an intoxicated person, research has shed more light on how alcohol abuse results in impaired host defenses. When managing pneumonia in an alcoholic patient, keep in mind that the pathogen is more likely to be a Gram-negative bacillus or multidrug-resistant Streptococcus pneumoniae. The treatment of ARDS is the same for alcoholics as it is for nonalcoholics; however, early identification of high-risk patients could help prevent the development of ARDS. (J Respir Dis. 2006;27(9):380-392).