TABLE 1.
Extracted results from the included studies in the review
| First author [ref.] | Country | Year | Study design | Subjects, n (male/female) | Alcohol consumption | Study population | Results |
| Negative effects | |||||||
| Emirgil [31] | USA | 1974 | Cross-sectional | 23 (19/4) | Pint years: pints per day times the number of years of intake | Selected group from detoxification unit | TLC, RV, VC and FEV1 declined with increasing alcohol consumption |
| Emirgil [42] | USA | 1977 | Cross-sectional | 44 (25/19) | Pint years: pints per day times the number of years of intake | Selected group from members of Alcoholics Anonymous | 64% of subjects had abnormal expiratory flow rates, 39% had an elevated value for the ratio of RV to TLC SBDC was abnormal in 16% |
| Sarić [43] | Yugoslavia USA |
1977 | Cross-sectional | 763 (763/0) | None or occasional: ≤0.5 L wine daily Daily: >1 L wine and spirits per day |
Selected group of workers from a ferromanganese factory, an electrode production factory and a light metal plant | Reduced FVC was primarily connected with age, and when all three factors (alcohol, smoking and age) were combined Reduced FEV1 was associated with alcohol consumption and age separately but not smoking habit Alcohol consumption combined with age and when all three factors (alcohol, smoking and age) were combined was statistically significant |
| Lebowitz [46] | USA | 1981 | Cross-sectional | 2637 (1164/1473) | Non-/light drinkers: <0.25 ounces·week−1 Moderate drinkers: 0.25–6.25 ounces·week−1 Heavy drinkers: >6.25 ounces·week−1 |
Population sample of white non-Mexican Americans residing in Tucson Arizona | Negative correlation in young male and female heavy smokers between total amount of alcohol consumed and FEV1 and FVC |
| Oleru [22] | USA Nigeria |
1987 | Cross-sectional | 60 (60/0) | Bottle-years: number of bottles of beer consumed per day times the number of years of intake | Selected group of workers in a cotton textile factory in Lagos | Lifetime alcohol intake was negatively correlated with pulmonary function and obstructive and restrictive pulmonary disease parameters Together with weight, alcohol bottle-years accounted for 18–22% of the variation in pulmonary function in a forward and reverse stepwise regression analysis |
| Lange [23] | Denmark | 1988 | Longitudinal | 8765 (3751/5014) | ALC1: Never or rarely a monthly drink ALC2: <30 g·week−1 ALC3: ≥30–<140 g·week−1 ALC4: ≥140–<350 g·week−1 ALC5: >350 g·week−1 |
Population-based study | Loss of FEV1 and FVC tended to be greater in the group with highest alcohol consumption compared to the other groups Alcohol consumption was positively correlated to the annual decrease in FEV1 and FVC |
| Zureik [26] | France | 1996 | Cross-sectional Longitudinal |
328 (328/0) | 1) 0–25 g·day−1 2) 26–60 g·day−1 3) >60 g·day−1 |
Selected group of policemen | In both 1980 and 1990 surveys age and height adjusted FEV1 was negatively associated with alcohol consumption and GGT Adjustment for covariates did not alter the results When daily alcohol consumption and log GGT were fitted as continuous variables in the multiple regression model, the test of trend was all significant VC displayed associations with alcohol consumption and GGT categories like those observed for FEV1 |
| Ström [25] | Sweden | 1996 | Cross-sectional | 478 (478/0) | 1) 0–40 g·week−1 2) 41–115 g·week−1 3) >115 g·week−1 |
Selected group of men born in even months in 1914 in Malmö | All men: after correction for smoking status and BMI, TLC and RV were significantly positively related to alcohol intake Current smokers: after correction for current tobacco consumption and BMI, TLC and RV were significantly positively correlated with alcohol intake Smokers with obstruction: after correction for current tobacco consumption and BMI, TLC and RV were significantly positively correlated with alcohol intake |
| Frantz [36] | Sweden | 2014 | Cross-sectional | 450 (185/265) | Based on AUDIT: 1) nondrinkers 2) moderate drinkers 3) hazardous drinkers CDT ≥2.0%: heavy alcohol consumption |
Population-based study | Heavy drinking (CDT level) compared to nonheavy drinkers were associated with lower FEV1/VC and DLCO For heavy and nonheavy drinkers, a significant difference was seen for DLCO when adjustments were made for several covariates After adjusting for crude lung function variables for covariates, a higher CDT was associated with lower FEV1, VC, FEV1/VC and DLCO Multiple regression showed an association between CDT and both FEV1 and DLCO in all alcohol drinkers but not in never-smokers |
| Sorli-Aguilar [37] | Spain | 2016 | Cross-sectional | 207 (91/116) | Units·week−1 Divided into: 1) lower tertile 2) middle tertile 3) upper tertile |
Randomised smokers without respiratory disease selected from 20 primary healthcare centres | More than two- or three-times prevalence of impaired lung function in the medium and highest tertiles of the alcohol-consumption pattern compared with the lowest The differences between tertiles were more intense in women |
| No effects | |||||||
| Cohen [44] | USA | 1980 | Cross-sectional | 2519 (1282/1237) | Based on quantity, frequency and maximal consumption: 1) light 2) moderate 3) heavy |
Population-based study | Unadjusted mean values of FEV1/FVC were significantly lower for heavy than for light drinkers The differences disappeared when adjustment was made for confounding factors There was also no evidence of an association between alcohol consumption and airway restriction |
| Sarkar [45] | USA | 1980 | Cross-sectional | 10 (9/1) | Pint-years: average daily consumption times number of years of alcoholism |
Selected group from the medical service of the Hospital for Joint Diseases and Medical Center, New York, and outpatients All were chronic heavy drinkers and nonsmokers |
Mean values in all pulmonary function studies were within normal limits |
| Sparrow [47] | USA | 1983 | Cross-sectional Longitudinal |
1067 (1067/0) | 1) 0–0.25 ounces·week−1 2) 0.26–6.25 ounces·week−1 3) >6.25 ounces·week−1 |
Selected group of white men from the Veterans Administration Outpatient Clinic in Boston | A multiple regression analysis indicated that alcohol consumption did not significantly influence baseline levels of FVC or FEV1 after controlling for covariates Alcohol consumption did not significantly influence follow-up levels of FVC or FEV1 after controlling several covariates |
| Lyons [48] | UK | 1986 | Case–control | 27 (21/6) | 1) 0–0.25 ounces·week−1 2) 0.26–6.25 ounces·week−1 3) >6.25 ounces·week−1 |
Selected subjects who were referred for assessment and treatment of various alcohol-related problems | No difference in pulmonary function between alcoholics and controls |
| Hoffstein [21] | Canada | 1987 | Longitudinal | 33 (32/1) | Alcoholics: 1) on average 80 g·day−1 or more of ethanol ≥3 months prior or 2) on average 160 g·day−1 ethanol ≥1 month prior |
Selected group of alcoholics admitted to the Addiction Research Foundation Clinical Institute within 5 days of their last drink | In smoking alcoholics, short-term abstinence from alcohol did not influence pulmonary function Mean values of FVC, FEV1 and ratio were within normal range |
| Garshick [24] | USA | 1989 | Cross-sectional | 165 (165/0) | Based on quantity and frequency kg·year−1 and g·month−1 Divided into: 1) lower tertile 2) middle tertile 3) upper tertile |
Selected population from the population of veterans in Southeastern Massachusetts Subjects recruited from the alcohol detoxification and rehabilitation wards The study cohort also included male hospital employees |
Alcohol consumption tended to have a negative effect on FEV1/height2 |
| Shin [29] | Korea | 2003 | Cross-sectional | 1160 (483/677) | 1) 0 drinks·week−1 2) 1–7 drinks·week−1 3) 8–21 drinks·week−1 4) ≥22 drinks·week−1 |
Population-based study | The odds of airway obstruction increased with increasing alcohol intake |
| Tang [32] | Hong Kong | 2005 | Cross-sectional | 300 (300/0) | AUDIT, cut-off score: 8 | Selected subjects from Hong Kong who sought compensation for pneumoconiosis | The drinking group had a higher unadjusted FEV1 predicted than the nondrinking group The differences between the FEV1 of the two groups was not significant after adjustments for covariates |
| Zifodya [41] | USA | 2022 | Cross-sectional | 350 (241/109) | 1) AUDIT, cut off score: 8 2) Lifetime alcohol exposure in grams 3) Early life alcohol use (frequency of alcohol use from 10 to 20 years old and from 21 to 30 years old) 4) Recent alcohol use (measured by whole-blood spot phosphatidyl ethanol level) 5) Alcohol use latent class: Heavy drinkers, former heavy drinkers, heavy drinkers with problems and low-risk drinkers |
Selected subjects of people living with HIV in Louisiana | In adjusted models, total lifetime alcohol use was not associated with FEV1, FVC or FEV1/FVC In multivariable models no association of AUDIT score with FEV1, FVC and ratio was found; a similar result was found related to early alcohol use |
| Positive effects | |||||||
| Tabak [27] | The Netherlands | 2001 | Cross-sectional | 13 651 (6279/7372) | 1) None or ≤1 drink·week−1 2) >1 drink·week−1 and ≤3 drinks·day−1 3) >3 drinks·day−1 |
Population-based study | In subjects with low alcohol consumption the FEV1 was higher than in nondrinkers |
| Schünemann [28] | USA | 2002 | Cross-sectional | 1555 (741/814) | 1) Never drinkers: <12 drinks in a lifetime 2) Not current drinkers: ≥12 or more drinks in a lifetime, no intake in the past 30 days 3) Current drinkers: alcohol intake in the past 30 days In current drinkers, grams of alcohol calculated |
Population-based study | Positive associations were found between recent and lifetime wine intake and FEV1 and FVC When analysing white and red wine intake separately, the association of lung function with red wine was weaker than for white wine |
| Sisson [30] | USA | 2005 | Cross-sectional | 15 294 (7135/8159) | 1) Lifetime never-drinker 2) Former heavy drinker 3) <5 drinks·month−1 4) 5–14 drinks·month−1 5) 15–30 drinks·month−1 6) 31–90 drinks·month−1 7) >90 drinks·month−1 |
Population-based study | Low to moderate alcohol intake was associated with better FVC and FEV1 in the absence of obstruction, consistent with reduced odds for lung restriction |
| Hansel [33] | France | 2010 | Cross-sectional | 149 773 (97 406/52 367) | 1) No consumption, 2) Low: fewer than 1 glass·day−1 3) Moderate: 1–3 glasses·day−1 4) High: >3 glasses·day−1 5) Former drinkers |
Population-based study | In both genders, respiratory function assessed by FEV1 was highest in moderate drinkers and lowest in never-drinkers Similar results after adjustment for tobacco consumption |
| Siedlinski [35] | The Netherlands | 2012 | Longitudinal | 3224 (1560/1664) | Grams of wine per day | Population-based study | The intake of white wine was associated with higher FEV1 level Significant interaction of pack-years smoked and white wine intake with the FEV1 This interaction reflected an association between white wine consumption and higher FEV1 in heavy smokers only White wine intake was significantly associated with a decreased risk of airway obstruction |
| Vasquez [38] | USA | 2018 | Longitudinal | 1333 (60–62% female participation in each survey) | Longitudinal drinking categories: 1) never-drinker 2) inconsistent drinker 3) persistent drinker Quantative drinking exposure (drinks·month−1): 1) none 2) <5 3) 5–<15 4) 15–<30 5) 30–<90 6) 90–<140 |
Population-based study of non-Hispanic white households in Arizona | After adjustment for several covariates, as compared to never drinkers, persistent drinkers had higher FVC but a lower ratio Differences were due to a slower decline of FVC among persistent than never-drinkers and these trends were present independent of smoking status Inconsistent drinking showed similar but weaker associations After adjustment for potential confounders, light to moderate alcohol consumption was associated with a significantly decreased rate of FVC decline over adult life and associated with protection from restriction |
| Choi [39] | Korea | 2020 | Cross-sectional | 3262 (1801/1461) | AUDIT, cut-off score: 8 | Population-based study | In nonsmokers, men with AUDIT score ≥8 demonstrated a significantly higher FEV1/FVC than those with AUDIT score <8 |
| Makino [16] | Japan | 2021 | Cross-sectional Longitudinal |
Cross-sectional: 6036 (3696/2340) Longitudinal: 1765 (1148/617) |
Based on quantity and frequency, g·week−1 were calculated and divided into: 1) never-drinker 2) light 3) moderate 4) heavy |
Population-based study | Moderate alcohol consumption was positively correlated with FEV1 and FVC in the cross-sectional study In the longitudinal study over 5 years higher baseline alcohol consumption, as well as increased alcohol intake over 5 years attenuated time-related deterioration of FVC without affecting total lung volume This effect was independent of smoking |
| Wang [40] | China | 2022 | Cross-sectional Longitudinal |
Cross-sectional: 16 268 (6451/9817) Longitudinal: 8914 (not available) |
Noncurrent drinkers: weekly intake previous 6 months; otherwise, they were regarded as nondrinkers, including never-drinkers and former drinkers Drinkers were further divided into: 1) moderate drinkers 2) heavy drinkers |
Population-based study | Compared with nondrinkers, moderate alcohol intake was significantly associated with increases in FEV1 and FVC, after adjusting for covariates Regarding beverage type, red wine was associated with increases in FEV1 and FVC in the total population Moderate alcohol intake was also associated with increases in FEV1 and FVC for liquor and red wine In the longitudinal analyses, moderate alcohol intake and red wine were associated with increases in FVC, respectively |
| U-shape association | |||||||
| Tabak [4] | The Netherlands | 2001 | Cross-sectional | 2953 (2953/0) | 1) No alcoholic drinks 2) ≤1 drink·week−1 3) >1 drink·week−1 and ≤3 drinks·day−1 4) >3 and ≤9 drinks·day−1 5) >9 drinks·day−1 |
Population-based study in Italy, the Netherlands and Finland | In Finland and the Netherlands, pulmonary function was higher in occasional and light drinkers (>0 and <30 g·day−1) compared with nondrinkers In Italy, very heavy drinkers had a lower FEV0.75 than moderate-to-heavy drinkers (>3 and <12 drinks·day−1) |
| Siu [34] | USA | 2010 | Cross-sectional | 177 721 (81 498/96 223) | 1) No alcohol 2) ≤2 drinks·day−1 3) 3–5 drinks·day−1 4) ≥6 drinks·day−1 |
Population-based study with members of a comprehensive health plan | Light to moderate drinkers of alcohol had better FEV1, FVC and FEV1/FVC than abstainers Heavier drinkers had worse lung function |
AUDIT: Alcohol Use Disorders Identification Test; BMI: body mass index; CDT: carbohydrate-deficient transferrin; DLCO: diffusing capacity of the lungs for carbon monoxide; FEV0.75: forced expiratory volume in 0.75 s; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; GGT: gamma-glutamyl-transferase; RV: residual volume; SBDC: single breath diffusing capacity; TLC: total lung capacity; VC: vital capacity.