title: Exhaled Nitric Oxide Levels Among Adults With Excessive Alcohol Consumption.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Health Sciences Campus, Maywood, IL; Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL; Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL. Electronic address: majid.afshar@luhs.org.
authors.forename: Majid
authors.initials: M
authors.lastname: Afshar
authors.affiliation: Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Poole
authors.affiliation: Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL.
authors.forename: Guichan
authors.initials: G
authors.lastname: Cao
authors.affiliation: Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL.
authors.forename: Ramon
authors.initials: R
authors.lastname: Durazo
authors.affiliation: Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Cooper
authors.affiliation: Department of Surgery, Loyola University Chicago Health Sciences Campus, Maywood, IL; Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences, Maywood, IL.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Kovacs
authors.affiliation: Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Sisson
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000378:metabolism / Q000503:physiopathology; D001944:Breath Tests / Q000379:methods; D002097:C-Reactive Protein; D045853:Exhalation / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D011237:Predictive Value of Tests; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000378:metabolism
chemical_list: D009569:Nitric Oxide; D002097:C-Reactive Protein
keywords: C-reactive protein; airway inflammation; alcohol; epidemiology (pulmonary); exhaled nitric oxide