The effects of acute ethanol ingestion on pulmonary diffusing capacity

Sensitivity of SARS-CoV-2 towards Alcohols: Potential for Alcohol-Related Toxicity in Humans

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative organism that is highly contagious and has been responsible for more than 240 million cases and 5 million deaths worldwide. Using masks, soap-based hand washing, and maintaining social distancing are some of the common methods to prevent the spread of the virus. In the absence of any preventive medications, from the outset of pandemic, alcohol-based hand sanitizers (ABHS) have been one of the first-line measures to control transmission of Coronavirus Disease 2019 (COVID-19). The purpose of this narrative review is to evaluate the sensitivity of SARS-CoV-2 towards ABHS and understand their potential adverse effects on humans. Ethanol and isopropanol have been the most commonly used alcohols in ABHS (e.g., gel, solution, spray, wipes, or foam) with alcohol in the range of 70–85% v/v in World Health Organization or Food and Drug Administration-approved ABHS. The denaturation of proteins around the envelope of SARS-CoV-2 positive sense single-stranded RNA virus is the major mechanism of action of ABHS. Due to frequent use of high-percentage alcohol-containing ABHS over an extended period of time, the oral, dermal, or pulmonary absorption is a possibility. In addition to the systemic toxicity, topical adverse effects such as contact dermatitis and atopic dermatitis are plausible and have been reported during COVID-19. ABHS appear to be effective in controlling the transmission of SARS-CoV-2 with the concern of oral, dermal, or pulmonary absorption.

2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung

This document provides an update to the European Respiratory Society (ERS)/American Thoracic Society (ATS) technical standards for single-breath carbon monoxide uptake in the lung that was last updated in 2005. Although both D_LCO (diffusing capacity) and T_LCO (transfer factor) are valid terms to describe the uptake of carbon monoxide in the lung, the term D_LCO is used in this document. A joint taskforce appointed by the ERS and ATS reviewed the recent literature on the measurement of D_LCO and surveyed the current technical capabilities of instrumentation being manufactured around the world. The recommendations in this document represent the consensus of the taskforce members in regard to the evidence available for various aspects of D_LCO measurement. Furthermore, it reflects the expert opinion of the taskforce members on areas in which peer-reviewed evidence was either not available or was incomplete. The major changes in these technical standards relate to D_LCO measurement with systems using rapidly responding gas analysers for carbon monoxide and the tracer gas, which are now the most common type of D_LCO instrumentation being manufactured. Technical improvements and the increased capability afforded by these new systems permit enhanced measurement of D_LCO and the opportunity to include other optional measures of lung function.

Sources of Long-term Variability in Measurements of Lung Function

BACKGROUND

The objective of the study was to characterize the biological and technical components of variability associated with longitudinal measurements of FEV(1) and carbon monoxide diffusing capacity (Dlco). Variability was apportioned to subject and instrument for five commercially available pulmonary function testing (PFT) systems: Collins CPL (Ferraris Respiratory; Louisville, CO); Morgan Transflow Test PFT System (Morgan Scientific; Haverhill, MA); SensorMedics Vmax 22D (VIASYS Healthcare; Yorba Linda, CA); Jaeger USA Masterscreen Diffusion TP (VIASYS Healthcare; Yorba Linda, CA); and Medical Graphics Profiler DX System (Medical Graphics Corporation; St. Paul, MN).

METHODS

This was a randomized, replicated cross-over, single-center methodology study in 11 healthy subjects aged 20 to 65 years. Spirometry and Dlco measurements were performed at baseline, 3 months, and 6 months. Repetitive simulations of FEV(1) and Dlco were performed on the same instruments on four occasions over a 90-day period using a spirometry waveform generator and a Dlco simulator.

RESULTS

The coefficient of variation associated with repetitive measurements of FEV(1) or Dlco in subjects was consistently larger than that associated with repetitive simulated waveforms across the five instruments. Instrumentation accounted for 13 to 58% of the total FEV(1) and 36 to 70% of the total Dlco variability observed in subjects. Sample size estimates of hypothetical studies designed to detect treatment group differences of 0.050 L in FEV(1) and 0.5 mL/min/mm Hg in Dlco varied as much as four times depending on the instrument utilized.

CONCLUSIONS

These results provide a semiquantitative assessment of the biological and technical components of PFT variability in a highly standardized setting. They illustrate how instrument choice and test variability can impact sample size determinations in clinical studies that use FEV(1) and Dlco as end points.

The Effects of Ethanol Ingestion on the Accuracy of Pulmonary Diffusing Capacity Measurement

BACKGROUND

Erroneous diffusing capacity of the lung for carbon monoxide (Dlco) values as measured by spectrophotometry were observed at our facility in ethanol-intoxicated subjects. An atypical methane curve tracing was noted in these subjects.

STUDY OBJECTIVES

We hypothesized that ethanol intoxication interferes with Dlco measurements obtained using methane and designed a study to assess the blood ethanol level at which this occurs.

STUDY DESIGN

Dlco and breath ethanol levels were measured at baseline and after escalating doses of ethanol in seven healthy subjects.

SETTING

Pulmonary function testing laboratory of a university hospital.

PARTICIPANTS

Seven healthy volunteers.

INTERVENTIONS

Dlco measurement at baseline and after escalating doses of ethanol.

MEASUREMENTS AND RESULTS

We found no significant change in measured Dlco values for a wide range of blood ethanol levels (from 0.006 to 0.12 mg/dL). However, subsequently, an abnormal methane curve and Dlco were again observed in an intoxicated subject whose ethanol blood level was 0.22 mg/dL.

CONCLUSIONS

We conclude that interference between breath ethanol level and Dlco measurement exists only for blood ethanol levels well above the legal limit for intoxication. Based on our observations, we suggest that ethanol intoxication should be suspected when an abnormal Dlco measurement occurs along with an abnormal methane curve tracing. If intoxication is confirmed, precautions should be taken and referral for treatment of possible ethanol dependence should be offered.

Alcohol consumption, gamma-glutamyl transpeptidase (GGT), and pulmonary function: a cross-sectional and longitudinal study in working men

Epidemiological studies of the relationships between pulmonary function and reported alcohol intake showed inconsistent results. The use of biological markers of alcohol is needed. The objective of this study was to assess the relationships of alcohol consumption, assessed by a standardized questionnaire, and gamma-glutamyl transpeptidase (GGT), to forced expiratory volume in 1 sec (FEV1) level and decline over 10 years, in working men. Three hundred twenty-eight policemen aged 22-55 years were examined in 1980 (first survey) and again in 1990 (second survey). The two cross-sectional analyses used the 1980 data and the 1990 data separately. Longitudinal analysis used 1980 alcohol consumption and GGT values, and 10-year FEV1 decline. In both cross-sectional surveys, elevated alcohol consumption was significantly associated with impaired age-adjusted and height-adjusted FEV1. Further adjustment for smoking habit, education level, and asthmatic status did not alter these results. An increase of 25 g/day of alcohol was associated with 50.0 ml (95% confidence interval: 1.5 to 98.5) and 55.3 ml (95% confidence interval: 7.8 to 102.8) decrease of corresponding multivariate-adjusted FEV1 in 1980 and in 1990, respectively. GGT was also negatively associated with FEV1 in both cross-sectional surveys. Similar patterns of associations were also observed between vital capacity measurements and alcohol variables. In the longitudinal analysis, there was no relationship between either alcohol consumption or GGT and FEV1 decline. Findings suggest that alcohol consumption was associated with impaired lung function, but there was no evidence of accelerated FEV1 decline over 10 years related to alcohol consumption in this "healthy" population of middle-aged men.

Pulmonary function in smokers after short-term cessation of alcohol ingestion

To test whether acute alcohol withdrawal has an effect on pulmonary function, we studied 33 smoking alcoholics admitted for a four-week period of rehabilitation during which they consumed no alcohol. Flow-volume curves, lung volumes by body plethysmography, and single breath diffusing capacity for carbon monoxide were measured on admission, at two weeks, and at four weeks. We found no significant change in pulmonary function between the results on admission and after four weeks of abstinence from alcohol. We conclude that short-term cessation of alcohol did not significantly influence pulmonary function in our subjects.

Response of human mucociliary clearance to acute alcohol administration

To determine whether alcohol inhibits mucociliary clearance in humans, the clearance of deposited radiolabelled particles from the lung was measured in 12 volunteers. On one study day, immediately after inhalation of aerosol, the subject ingested ethyl alcohol (0.5 g/kg) in orange juice producing an average alcohol level at 1 hr of 68 +/- 8 mg/kl. On the other study day, orange juice alone was ingested. The initial deposition of aerosol and sequential measurements of lung retention were made during 4.7 hr and again at 24 hr using a gamma camera. Aerosol deposition patterns were reproducible within subjects. Group average percent bronchial retention during a 4.5-hr period was not significantly different between the control and the alcohol studies, but the variance in the alcohol studies during 0.5-4.5 hr was significantly greater (P less than .001). Comparison of data to a previous study group of matched control subjects confirmed an increased variability in clearance after alcohol. Thus, acute alcohol ingestion, at levels similar to those achieved during social drinking, alters mucociliary clearance, but direction and magnitude of the changes differ among individuals.