Elsevier

Clinics in Chest Medicine

Volume 35, Issue 4, December 2014, Pages 625-637
Clinics in Chest Medicine

Environmental Risk Factors for Acute Respiratory Distress Syndrome

https://doi.org/10.1016/j.ccm.2014.08.003Get rights and content

Section snippets

Key points

  • Multiple observational studies have demonstrated that chronic alcohol use is a risk factor for the development of acute respiratory distress syndrome (ARDS).

  • Alcohol use may promote the development of ARDS via increased angiotensin II, producing increasing oxidative stress, which creates baseline alveolar epithelial dysfunction and primes the lung for developing noncardiogenic pulmonary edema.

  • Although less studied than alcohol use, cigarette smoke exposure also seems likely to be a risk factor

Alcohol abuse

Alcohol is one of the most commonly used and abused drugs worldwide. In the United States, nearly 20 million adults annually meet the criteria for alcohol abuse or dependence.1, 2 Alcohol is known to have numerous systemic health effects, including on the liver and central nervous system.3 From a respiratory standpoint, alcohol abuse has long been associated with an increased risk of pneumonia.4, 5 More recently, alcohol abuse has been strongly linked in epidemiologic studies to the development

Smoking

Smoking remains a global epidemic. Although antismoking efforts in the United States continue to slowly decrease the rate of smoking among adults (currently 18.1%),55 tobacco use continues to be the leading cause of preventable death both in the United States and worldwide, killing nearly 6 million people annually.56 Although many harmful effects of smoking, particularly on the lung, have been known for quite some time, the link between ARDS and smoking has been established only recently.

Early

Air pollution

Air pollution has been associated with a variety of adverse health outcomes, including all-cause mortality.94 It is thought that this phenomenon is driven primarily by an increase in cardiorespiratory events. Several epidemiologic studies have shown that air pollution is associated with an increased risk of myocardial infarction and cardiovascular disease mortality.95, 96, 97, 98 The association between air pollution and respiratory mortality is less clear, with some studies showing an increase

Summary

Significant progress has been made since the search for environmental risk factors for ARDS began nearly 2 decades ago. Chronic alcohol use and smoking have been identified in numerous studies to independently increase the risk of developing ARDS and potentially affect the outcomes of patients who go on to develop the disease. These findings have important implications for public health and for ARDS prevention. Additionally, scientific studies have yielded tremendous insight into many of the

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    Disclosure: Dr. Calfee has received grant funding from and served on medical advisory boards for Glaxo Smith Kline.

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