Covid-19 and ARDS
A common complication seen in Covid-19 patients is the Acute Respiratory Distress Syndrome or ARDS. In ARDS, the lungs become filled with fluid. The congested lungs cannot expand and allow air to come in for gas exchange. This results in a life-threatening low oxygen level in the body.
ARDS comes to the point that oxygen supplementation with a nasal cannula is not enough. The next step in a rapidly crashing patient is to insert a tube into the windpipe and connect to a mechanical ventilator to provide adequate oxygenation. The patient is heavily sedated with medicines once this happens.
In ARDS, the immune response is excessive and destroys not only the virus but also the lungs. ARDS has a high mortality rate.
ARDS can also arise in people who do not have Covid-19. Patients with alcohol abuse disorders who have viral or bacterial pneumonia are at a higher risk of developing ARDS. Chronic use of alcohol affects the lungs’ immune response in many ways.
How Alcohol Abuse Worsens Lung Infections
1. Alcohol impairs the Lungs’ Mechanical protection
Along the inner lining of the airways that go to the lungs, there are minute hair-like projections called cilia. They work together to sweep away dust and microbes away from the lungs. Just imagine someone doing “crowd surfing.”
Alcohol abuse destroys that ciliary protective mechanism and allows germs to hang around and enter the cells. Once inside, they multiply to cause an infection.
2. Alcohol diminishes the effectiveness of the white blood cells
Alcohol decreases the production of white blood cells (WBCs) from the bone marrow. WBCs rise in response to infections. Thus even before a disease, there is already a disadvantage.
In an infection, neutrophils, a type of white blood cells (WBCs) need to show up at the site of infection as the first line of defense. That is called neutrophile recruitment. As the neutrophils get there, they “eat” or phagocytose the germs to neutralize and process them.
When microbes get “eaten,” the neutrophils produce signaling proteins called cytokines. Cytokines are like text messages that are sent out to other cells and serve as their means of communication. Some cytokines stimulate WBCs called macrophages and lymphocytes and involve them in fighting viral infections.
Alcohol abuse hampers, white blood cell production, weakens neutrophil recruitment, phagocytosis, and cytokine production.
3. Alcohol abuse makes the lung prone to fluid accumulation
The working unit of the lungs is a small air sac called the alveoli. Within the alveoli is where oxygen is transferred from the air into the blood. In exchange, carbon dioxide is transferred from the blood into the air inside the alveoli to be exhaled. For this to happen, the alveoli have very thin walls for the gases to pass thru.
Lubrication is needed to provide elasticity to the lungs as it expands and contracts with inhalation and exhalation. A delicate mechanism of controlling the amount of fluid in the lungs is needed to maintain the right amount of lubricating fluids.
When alcohol abusers get an infection, that fluid balance goes away. The thin wall of the alveoli and the air spaces becomes soaked with liquids.
The result is that the space inside the alveoli that are needed for gas exchange becomes unusable, and the body’s oxygen levels drop.
4. Alcohol decreases the anti-oxidants of the lung.
The lung tissue is prone to oxidation. Oxidation is a normal process that is needed for cellular function. In excess, oxidation can cause oxidative cell damage.
To prevent oxidative damage, the body produces anti-oxidants. One of them is glutathione.
Chronic alcohol abuse decreases glutathione levels. The lack of glutathione leads to abnormal changes to the cells and alterations in the fluid shifts of the lungs. It also interferes with the function of a particular type of WBC called macrophages to protect the lungs against infections.
The lack of glutathione in alcohol abuse decreases the lungs’ ability to fight infection and also causes early death of the lung cells in the presence of disease.
Alcohol, Covid-19, and ARDS
The relationship between chronic alcohol abuse and ARDS is well established. Alcohol abusers are two to four times more likely to develop ARDS. [1], [2]
Together with Covid-19, it is very possible that developing ARDS among alcohol abusers would be very high. A list of websites are provided below for those interested in cutting down or stopping alcohol use.
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References:
- Samantha M. Simet, Ph.D., and Joseph H. Sisson, M.D. Alcohol’s Effects on Lung Health and Immunity. ALCOHOL RESEARCH: Current Reviews. Alcohol Res. 2015; 37(2): 199–208.
- Thakur et al. Alcohol Consumption and Development of Acute Respiratory Distress Syndrome: A Population-Based Study. Int J Environ Res Public Health. 2009 Sep; 6(9): 2426–2435. Published online 2009 September 10. doi: 10.3390/ijerph6092426
- Glutathione depletion in chronic alcohol abuse makes the lungs vulnerable to life-threatening diseases. EurekAlert!. April 4, 2002
- The Hematological Complications of Alcoholism. HAROLD S. BALLARD, M.D.
Image Credit:
ARDS and Normal Chest X-ray Altaf Gauhar Haji, Shekhar Sharma, DK Vijaykumar and Jerry Paul. / CC BY (https://creativecommons.org/licenses/by/2.0)
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