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Original Research: Allergy and Airway |

Exhaled Nitric Oxide Levels Among Adults With Excessive Alcohol Consumption

Majid Afshar, MD, MSCR; Jill A. Poole, MD; Guichan Cao, MS; Ramon Durazo, PhD; Richard C. Cooper, MD; Elizabeth J. Kovacs, PhD; Joseph H. Sisson, MD
Author and Funding Information

Dr Kovacs is currently at the Department of Surgery, University of Colorado (Aurora, CO).

FUNDING/SUPPORT: This research was supported in part by National Institutes of Health [grants R01 AA008769-23 (J. H. S.) and R01 GM115257-14 (E. J. K.)], and by the Loyola Research Funding Committee (M. A.).

aDivision of Pulmonary and Critical Care Medicine, Loyola University Chicago Health Sciences Campus, Maywood, IL

bDepartment of Surgery, Loyola University Chicago Health Sciences Campus, Maywood, IL

cDepartment of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL

dAlcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL

eBurn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL

fDivision of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Nebraska Medical Center, Omaha, NE

CORRESPONDENCE TO: Majid Afshar, MD, MSCR, 2160 S First Ave, Bldg 54, Maywood, IL 60153


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(1):196-209. doi:10.1016/j.chest.2016.02.642
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Published online

Background  More than one-quarter of the US population qualify as excessive alcohol consumers. Alcohol use impacts several lung diseases, and heavy consumption has been associated with poor clinical outcomes. The fractional excretion of exhaled nitric oxide (Feno) has clinical implications in multiple airways diseases. We hypothesized that excessive alcohol intake is associated with lower Feno levels.

Methods  To test this hypothesis, we examined a sample consisting of 12,059 participants, aged 21 to 79 years, interviewed between 2007 and 2012 from the National Health and Examination Survey. Two valid Feno measurements that were reproducible were recorded. Alcohol questionnaire data were used to define the following alcohol groups: never drinkers, nonexcessive drinkers, excessive drinkers, and former excessive drinkers. The natural logarithm of Feno values [ln(Feno)] as well as blood eosinophil count and C-reactive protein were used as dependent variables to test the association with alcohol groups including multivariable linear regression models with adjustment for predictors of Feno.

Results  Excessive alcohol consumption comprised 3,693 (26.9%) of the US sample population. Controlling for all other factors, excessive alcohol consumption had a negative association and was an independent predictor for ln(Feno) levels in comparison with the never-drinker group (−0.11; 95% CI, −0.17 to −0.06; P < .001). ln(Feno) levels decreased across categories of increasing alcohol use (P < .001).

Conclusions  Accounting for alcohol use in the interpretation of Feno levels should be an additional consideration, and further investigations are warranted to explore the complex interaction between alcohol and nitric oxide in the airways.

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