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This Article Full Text (PDF) All Versions of this Article: chest.07-3081v1 134/4/761    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Greene, C. C. Articles by Au, D. H. PubMed PubMed Citation Articles by Greene, C. C. Articles by Au, D. H.

The Association between Alcohol Consumption and Risk of COPD Exacerbation in a Veteran Population.

From the Health Services Research & Development, Seattle, Washington (DHA, CLB, KAB, EMU); the Primary and Specialty Medical Care Service, Seattle, Washington, VA Puget Sound Health Care System, Seattle, Washington (DHA, CLB, KAB); the Department of Medicine, University of Washington, Seattle, Washington (CCG, DHA, CLB, KAB); the Department of Pharmacy, University of Washington, Seattle, Washington (DKB); and New York University, Department of Medicine (LEE)

dau{at}u.washington.edu

Abstract

BackgroundAlcohol has been associated with COPD related mortality, but has not yet been demonstrated to be an independent risk factor for COPD exacerbation. Our objective was to evaluate the association between alcohol consumption and subsequent risk of COPD exacerbation. Methods: Prospective cohort study of General Medicine outpatients seen in one of 7 Veteran Affairs (VA) medical centers who returned health screening questionnaires. Three screening questionnaires, AUDIT-C (0-12 points), CAGE (0-4 points), and a single item about the frequency of drinking 6 or more drinks on an occasion (binge drinking) were used to classify alcohol consumption. The main outcome, COPD exacerbation, was based on primary VA discharge diagnosis (ICD-9) or outpatient diagnosis of COPD accompanied by prescriptions for either antibiotics or prednisone within 2 days. Results: Among the 30,503 patients followed for a median of 3.35 years, those patients with AUDIT-C scores 6, CAGE score 2 or who reported binge drinking at least weekly were at an increased risk of COPD exacerbation in age-adjusted analysis. Adjusted HR were 1.4 (95% Confidence intervals: 1.1-1.7) for AUDIT-C score 6, 1.4 (1.3-1.5) for CAGE 2, and 1.6 (1.2-2.2) for those that reported binge drinking daily or almost daily. However, with adjustment for measures of tobacco use the association between alcohol consumption and increased risk of COPD exacerbation was no longer evident. Conclusions: Alcohol consumption, whether quantified by AUDIT-C, CAGE score or binge drinking, was not associated with an increased risk of COPD exacerbation independent of tobacco use.

Key Words: Pulmonary disease • Chronic obstructive • Epidemiology • Alcohol drinking and adverse effect