Alcohol Consumption and Risk of Chronic Obstructive Pulmonary Disease

A Prospective Cohort Study of Men

Joanna Kaluza; Holly R. Harris; Anders Linden; Alicja Wolk

Disclosures

Am J Epidemiol. 2019;188(5):907-916. 

In This Article

Abstract and Introduction

Abstract

Studies indicate an inverse association between moderate alcohol consumption and chronic inflammatory diseases; however, the association between alcohol consumption and chronic obstructive pulmonary disease (COPD) incidence has not been widely studied. We investigated the associations of total alcohol consumption and intake of specific alcoholic beverages with risk of COPD in a population-based prospective cohort study, the Cohort of Swedish Men (n = 44,254). Alcohol consumption was assessed with a self-administered questionnaire in 1997. During follow-up (1998–2014), 2,177 COPD cases were ascertained. Moderate alcohol consumption was associated with the lowest risk of COPD. A J-shaped association was observed for ethanol consumption (P for nonlinearity = 0.003) and beer consumption (P for nonlinearity < 0.001); for wine consumption, a U-shaped association was observed (P for nonlinearity < 0.001). Defining a "standard drink" as 12 g of ethanol, the multivariable-adjusted hazard ratios were 0.77 (95% confidence interval (CI): 0.66, 0.90) and 0.92 (95% CI: 0.81, 1.05) for beer consumption of 4.1–6.0 and >6.0 standard drinks/week (SDW) versus <1.0 SDW, respectively; 0.80 (95% CI: 0.69, 0.93) and 1.00 (95% CI: 0.83, 1.21) for wine consumption of 2.0–4.0 and >4.0 SDW versus <1.0 SDW, respectively; and 1.10 (95% CI: 0.98, 1.24) and 1.20 (95% CI: 0.99, 1.44) for liquor consumption of 2.0–4.0 and >4.0 SDW versus <1.0 SDW, respectively. In conclusion, our findings suggest that moderate beer and wine consumption, but not liquor consumption, may decrease risk of COPD. Additional studies are needed to confirm these associations.

Introduction

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation, and it is accompanied by chronic inflammation. The disease usually develops because of exposure to noxious particles or gases which cause airway and/or alveolar abnormalities, with cigarette smoking being the main risk factor.[1] According to investigators in the Global Burden of Disease Study, COPD was the third leading cause of loss of life in the United States and the fourth leading cause in the United Kingdom in 2016,[2] and it is globally a relevant cause of increases in disability-adjusted life years.[3] It is a global challenge to determine modifiable risk factors and create public programs to prevent and reduce risk factors for COPD.

Until now, dietary patterns[4–6] and consumption of specific foods, such as fruits and vegetables[7,8] and red meat,[9–12] have been investigated in relation to COPD risk in prospective studies; however, few studies have examined the association between alcohol consumption and risk of COPD. Further, only total alcohol intake in relation to COPD mortality[13,14] or COPD-related deaths[15] has been examined in prospective studies. These results have indicated decreased risk of COPD mortality in people with low-to-moderate alcohol consumption compared with people with high consumption.[13–15] Moreover, in a cohort study, risk of COPD hospitalization was lower among participants who consumed 1–2 alcoholic drinks/day versus nonconsumers, and similar associations were observed regardless of type of alcohol consumed (i.e., wine, beer, or liquor).[16] In a study examining alcohol consumption and lung function, alcohol consumption, especially heavy drinking, was associated with lower forced expiratory volume in 1 second among smokers.[17]

The influence of alcohol consumption on health is unclear, with an ongoing debate regarding the relationship between alcohol and mortality. In a recently published meta-analysis of 83 prospective studies, Wood et al.[18] found a positive and curvilinear association, with the lowest risk of all-cause mortality being observed among persons consuming less than 100 g of alcohol per week and a J-shaped association being observed for aggregate cardiovascular risk, with the lowest risk seen among those consuming 75–150 g per week. Given the lack of large prospective studies on the association between alcohol consumption and incidence of COPD and the focus of existing COPD mortality studies on total alcohol intake, our aim in this study was to assess whether total alcohol intake and intakes of specific alcoholic beverages were associated with risk of COPD in a population-based cohort study, the Cohort of Swedish Men.

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