I THOUGHT the best day to publish this blog was a Sunday…the day after the night before!
Asthma is basically an allergic reaction, the effects of which are felt predominantly in the lungs. The outcome of suffering this reaction is one or more of the classic symptoms of asthma e.g. a cough, wheeze or breathlessness.
Like an allergic reaction, there must be a substance or environment that causes the problem. In asthma, this causative factor is known as a trigger. The diagnosis and management of asthma still depend on taking a thorough clinical history. One of the key aims of this history is to identify asthma triggers with the helpful eventual aim of supporting the patient to avoid them.
One such trigger is alcohol…
There are a number of studies that show the adverse effects alcohol and its components: biogenic amines, histamine, sulphite additives and ethanol itself have been shown to trigger asthma exacerbations. These ingredients, or additives, are present to a greater or lesser degree depending on the alcoholic drink. For example, red wine and certain beers have higher levels of histamine. I was also interested to read that the Asian population is more susceptible than others to the effect of ethanol based on the fact that they are not as well equipped to metabolise acetylaldehydes.
I wondered which asthmatic patient group would be most at risk of an asthma attack triggered by alcohol. In my opinion, I think the young adult group who have just left home would be worth engaging with as community pharmacists. This group of asthmatics is already known to have a higher risk of a breakdown in control, especially if their parents were managing their preventative asthma care at home before they moved out. Combine this with alcohol-fuelled ‘party time’ at uni or as a young professional, and I think the risk of exacerbations will increase.
Patient education and a written asthma plan are the keys to preventing exacerbations in this asthmatic group who choose to drink alcohol.
The best and simplest advice to an asthmatic who has observed that their asthma control is affected by alcohol is to seek a review with their pharmacist, nurse or GP. It’s always a good idea to keep a reliever inhaler handy especially if alcohol is a known trigger for the individual. Of course, moderating levels of drinking could be key to avoiding a dangerous asthma attack too.
If you are the healthcare professional conducting the asthma review, I hope this blog has perhaps made you think about asking about alcohol consumption as part of your history, and consider it as a possible asthma trigger.
Johnathan Laird is a GP pharmacist independent prescriber with a special interest in asthma. He is based in based in Aberdeen.
Follow Johnathan @JohnathanLaird
References
[1] Vally H, Thompson PJ. Allergic and asthmatic reactions to alcoholic drinks. Addict Biol. 2003 Mar;8(1):3-11.
[2] Drink Aware unit calculator
[3] RH Dougherty, M.D, John V Fahy, M.D. Acute Exacerbations of Asthma: Epidemiology, Biology and the Exacerbation-Prone Phenotype. Clin Exp Allergy. 2009 Feb; 39(2): 193–202.
[4] Asthma UK: Asthma triggers