Alcohol, Immunosuppression, and the Lung

Infection in the immunocompromised host has generated much clinical concern and a wealth of studies instructing us on how to deal with such patients.¹,²These efforts have centered almost solely on the transplant recipient, the cancer patient, and, most recently, the male homosexual. However, the older clinical literature and the more recent basic science literature deal with the effects of alcohol—a not inconsequential fact considering that at least 10% of our population are alcoholics and billions of dollars are lost each year as a direct result of alcoholism.³,⁴ The metabolic effects of alcohol are well known.⁵These include decreased albumin synthesis, serum magnesium, serum phosphate, and gluconeogenesis with resultant hypoglycemia, increased lactate and ketone production, and increased drug metabolism and oxygen consumption. Subclinical vitamin deficiencies leading to cerebral impairment are also frequently observed.⁶ Alcoholics have more pulmonary symptoms and diseases. Epidemiologic studies show an increase in