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1. Epidemiology of Alcohol Abuse, ARDS, and Lung Injury
Alcohol abuse is defined as the recurring use of alcoholic beverages despite negative consequences [1]. Each year, alcohol abuse costs ~100,000 lives and ~$100 billion in healthcare expenditures in the US [2, 3]. In CDC analysis of 2010 drinking patterns [4], people aged 18–24 years had a higher prevalence (28.2%) and intensity (9.3 drinks/occasion) of alcohol use, but people ≥65 years had a higher frequency (5.5 episodes/month). Although households with incomes <$25,000 had the highest frequency (5.0 episodes/month) and intensity (8.5 drinks/occasion), households with incomes ≥$75,000 had the highest prevalence (20.2%). In addition to increasing the risks of developing an alcohol use disorder, alcohol abuse is problematic and often associated with increased medical risks such as cardiovascular disease, mal-absorption, chronic pancreatitis, alcoholic liver disease, and cancer. The higher incidence of sepsis or pneumonia in subjects that abuse alcohol results in a higher rate of admittance to an intensive care unit [5, 6], longer inpatient stays, higher healthcare costs [7], and a 2–4 times greater mortality rate [8–11]. Although long-term use of alcohol in excessive quantities is capable of affecting every organ system in the body, the investigation of the effects of alcohol on the lung is in its early stage. The most significant pulmonary effects of alcohol abuse are the increased risks of bacterial infection and acute lung injury (ALI).
Acute respiratory distress syndrome (ARDS) is recognized as the most severe form of acute lung injury, a form of diffuse alveolar injury with bilateral pulmonary infiltrates and severe hypoxemia in the absence of cardiogenic pulmonary edema [12]. Pathologically, ARDS is most commonly associated with diffuse alveolar damage characterized by inflammation of the lung parenchyma leading to impaired gas exchange with concomitant systemic release of inflammatory mediators causing inflammation and hypoxemia. The consequences of ARDS are severe, frequently resulting in multiple organ failure and death. A perspective study conducted in King County, Washington, found that the age-adjusted incidence of ALI was 86.2 per 100,000 person-years [13]. Based on these studies, it is estimated that 190,600 ARDS cases...