Alcohol, smoking and lung disease.

Alcohol and smoking are two well-known health hazards. Alcohol and tobacco consumption are strongly correlated and heavy drinkers have more trouble quitting smoking than do light drinkers. Death from tobacco-related causes was more common than alcohol-related death in a follow-up study on patients admitted to an addiction programme for treatment of alcoholism and non-nicotine drug dependence. In British male doctors in the middle and elderly age group, a protective effect of light and moderate alcohol consumption (1-3 British units of alcohol per day) compared with abstinence has been shown in one large survey. This protective effect was shown in overall mortality as well as in mortality from respiratory disease. Higher alcohol intakes were associated with an increase in mortality. This characteristic U-formed, or J-formed, dose-response curve has been found in most studies with an apparent beneficial effect of modest alcohol intake and a harmful effect of high intakes. The anti-inflammatory effect of alcohol has been considered to be responsible for its limited protective effect on smoking-related lung function decline. Recently, a hitherto unconfirmed report suggests that the beneficial effect of alcohol on lung function in men is restricted to subjects with Lewis-negative blood group (10% of the Caucasian population). On the other hand, the protective effect in those individuals is large enough to be clinically relevant. Prospective investigations including both men and women are needed to elucidate which individuals have a protective effect of light and moderate alcohol intake. The major deleterious effect of smoking, including passive smoking, must be kept in mind-drinking alcohol surrounded by cigarette smoke might not be beneficial for respiratory health.