Pneumonia and alcohol use disorder: Implications for treatment

Abstract

Community-acquired pneumonia is the most common cause of death due to infectious disease. 1 Its severity is infl uenced by patient factors such as age, sex, immune status, smoking, and comorbidities. 2 Alcohol use disorder (AUD) affects about 6% of the adult population in the United States. 3 It is common among patients hospitalized for pneumonia, 4 and there is a strong and consistent relationship between AUD and risk of community-acquired pneumonia. 5 Although strictly speaking, AUD is a psychiatric diagnosis, we will use the term to describe heavy alcohol consumption in general.

Alcohol Use and the Risk of Communicable Diseases

“…Clearly, the living conditions and behaviors, as well as alcohol-induced compromised immunity, hinder the healing process for people with lower respiratory infections [157]. Abstinence or at least an absence of heavy drinking occasions should thus be the norm during such infections, bearing in mind that for some people with AUD, abruptly abstaining may lead to alcohol withdrawal syndrome, which in itself may have severely negative effects [158].…”

“…Similarly, despite the role of alcohol use in increasing the risk of pneumonia acquisition, alcohol use reduction seems to be missing as part of a number of texts providing recommendations for the prevention of pneumonia (e.g., [189,190]). On the other hand, one of the main preventative measures for pneumonia is vaccination, and commentators have recommended vaccinating individuals with an AUD in order to prevent (re-)infection with pneumonia [158]. Others (e.g., [191]) have suggested that clinicians should identify individuals who are at high risk of developing pneumonia as potential candidates for pneumonia vaccinations due to their possession of risk factors, including alcohol use, smoking, older age, and lower socioeconomic status, among a few others [191].…”

“…Several recommendations regarding the treatment of patients with pneumonia who drink alcohol or have AUDs have been put forward. These include preventing further bouts of pneumonia by providing alcohol counseling [151] and pneumococcal vaccination [158]. Screening and brief interventions for AUDs among all patients undergoing treatment for pneumonia have also been recommended so that the clinician can be well informed about their patients' alcohol use and manage their pneumonia accordingly [150].…”

“…Screening and brief interventions for AUDs among all patients undergoing treatment for pneumonia have also been recommended so that the clinician can be well informed about their patients' alcohol use and manage their pneumonia accordingly [150]. Assessment for potential alcohol withdrawal syndrome that may occur as a result of abstinence is also recommended as it can have serious and even fatal consequences if not managed appropriately [158]. Providing guidelines on screening for the risk of AUDs and alcohol withdrawal syndrome to TB treatment providers has also been recommended [199].…”

Pneumonia risk prediction in patients with acute alcohol withdrawal syndrome through evaluation of sarcopenia index as a prognostic factor

“…In intensive care units, one-third of AWS patients developed pneumonia [ 7 ]. After pneumonia, AWS patients had a higher risk of hospitalization and intensive care unit admission than non-AWS patients [ 8 ]. Therefore, screening for the incidence of pneumonia is essential.…”