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Inhalational Ethanol Therapy in COVID-19 Treatment and Prevention

Background: Considering the proven anti coronavirus (SARS-CoV-2) and immunomodulatory effects of the ethanol, the efficacy of its administration was evaluated in this research. Because of respiratory tract entrance of virus and pulmonary involvement in COVID-19, this study was done by inhalation of nebulized ethanol. Methods: Ninety-nine symptomatic and positive SARS-CoV-2-PCR patients who had been admitted at a respiratory clinic to receive Remdesivir-Dexamethasone were included in this triple-blind trial study. Patients were randomly assigned to the control (placebo, distilled water spray) and intervention (35% ethanol spray) group. Both groups were instructed to inhale 3 puffs of spray (nebulizer) and breathe through the nose and mouth via a face mask, every six hours for a week. Global symptomatic score (GSS), clinical status scale (CSS) based on a 7-point ordinal scale ranging from death (category 1) to complete recovery (category 7), percentage of blood oxygen (with pulse oximeter), and C-Reactive Protein (CRP) level at the first visit and days 3, 7, 14 were measured and compared between the two groups. Results: GSS at the beginning of the study in the intervention group was similar to the control group (6.72±2.07 vs 6.67±2.09 respectively, P=0.91). Based on the analysis of repeated measures, the GSS decreased more and faster in the intervention group (ethanol) (1.4±1.4 vs 2.3±1.7, P=0.035) two weeks after starting intervention. On day 14, the odds of intervention group to have better clinical status was 5.715 times (95% CI, 2.47 to 13.19) than of control group a statistically significant effect, Wald χ2 (1) =16.67, P =0.001. Blood oxygen saturation also improved earlier in the ethanol group than in the control group, although the difference did not reach its statistical significance level (95.95%±2 vs 94.46%±1.8, P=0.097). The readmission rate after the complete period of treatment was lower in the intervention group (zero vs 10.9%, P=0.02). There was no need for intensive care unit hospitalization in both groups. The mortality rate was zero in both groups. Conclusion: Looking at the efficacy of the inhaled nebulized ethanol, its use seems to be effective in general rapid improvement, mitigating clinical symptoms and reducing the need to repeat treatment. Considering the low cost, availability and no significant adverse events of ethanol, research and additional efforts are recommended to evaluate its curative and preventive effects in the early stages of COVID-19.

COVID-19, Ethanol, Inhalation, Nebulizer

APA Style

Ali Amoushahi, Elham Moazam, Pietro Salvatori. (2023). Inhalational Ethanol Therapy in COVID-19 Treatment and Prevention. Advances in Surgical Sciences, 11(2), 22-28. https://doi.org/10.11648/j.ass.20231102.11

ACS Style

Ali Amoushahi; Elham Moazam; Pietro Salvatori. Inhalational Ethanol Therapy in COVID-19 Treatment and Prevention. Adv. Surg. Sci. 2023, 11(2), 22-28. doi: 10.11648/j.ass.20231102.11

AMA Style

Ali Amoushahi, Elham Moazam, Pietro Salvatori. Inhalational Ethanol Therapy in COVID-19 Treatment and Prevention. Adv Surg Sci. 2023;11(2):22-28. doi: 10.11648/j.ass.20231102.11

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Singh D, Joshi K, Samuel A, Patra J, Mahindroo N. Alcohol-based hand sanitisers as first line of defence against SARS-CoV-2: a review of biology, chemistry and formulations. Epidemiology & Infection. 2020; 148.
2. Lai MM, Cavanagh D. The molecular biology of coronaviruses. Advances in virus research. 1997; 48: 1-100.
3. Moorer W. Antiviral activity of alcohol for surface disinfection. International journal of dental hygiene. 2003; 1 (3): 138-42.
4. Mors K, Horauf J-A, Kany S, Wagner N, Sturm R, Woschek M, et al. Ethanol decreases inflammatory response in human lung epithelial cells by inhibiting the canonical NF-kB-pathway. Cellular Physiology and Biochemistry. 2017; 43 (1): 17-30.
5. Chandrasekar A, olde Heuvel F, Palmer A, Linkus B, Ludolph AC, Boeckers TM, et al. Acute ethanol administration results in a protective cytokine and neuroinflammatory profile in traumatic brain injury. International immunopharmacology. 2017; 51: 66-75.
6. Boe DM, Nelson S, Zhang P, Bagby GJ. Acute ethanol intoxication suppresses lung chemokine production following infection with Streptococcus pneumoniae. The Journal of infectious diseases. 2001; 184 (9): 1134-42.
7. Berres ME, Garic A, Flentke GR, Smith SM. Transcriptome profiling identifies ribosome biogenesis as a target of alcohol teratogenicity and vulnerability during early embryogenesis. PLoS One. 2017; 12 (1): e0169351.
8. Sakihara C, Jones KA, Lorenz RR, Perkins WJ, Warner DO. Effects of primary alcohols on airway smooth muscle. The Journal of the American Society of Anesthesiologists. 2002; 96 (2): 428-37.
9. Acevedo SF, Gonzalez DA, Rodan AR, Rothenfluh A. S6 Kinase reflects and regulates ethanol-induced sedation. Journal of Neuroscience. 2015; 35 (46): 15396-402.
10. Arout CA, Perrino Jr AC, Ralevski E, Acampora G, Koretski J, Limoncelli D, et al. Effect of intravenous ethanol on capsaicin-induced hyperalgesia in human subjects. Alcoholism: Clinical and Experimental Research. 2016; 40 (7): 1425-9.
11. Ekins BR, Rollins DE, Duffy DP, Gregory MC. Standardized treatment of severe methanol poisoning with ethanol and hemodialysis. Western Journal of Medicine. 1985; 142 (3): 337.
12. Myers R, Taljaard J. Blood alcohol and fat embolism syndrome. The Journal of bone and joint surgery American volume. 1977; 59 (7): 878-80.
13. Haas DM, Morgan AM, Deans SJ, Schubert FP. Ethanol for preventing preterm birth in threatened preterm labor. Cochrane Database of Systematic Reviews. 2015 (11).
14. Teran E, Racines-Orbe M, Vivero S, Escudero C, Molina G, Calle A. Preeclampsia is associated with a decrease in plasma coenzyme Q10 levels. Free Radical Biology and Medicine. 2003; 35 (11): 1453-6.
15. Gootnick A, Lipson HI, Turbin J. Inhalation of ethyl alcohol for pulmonary edema. New England Journal of Medicine. 1951; 245 (22): 842-3.
16. Ana Castro-Balado and all, Development and Characterization of Inhaled Ethanol as a Novel Pharmacological Strategy Currently Evaluated in a Phase II Clinical Trial for Early-Stage SARS-CoV-2 Infection, Pharmaceutics. 2021. Mar 5; 13 (3): 342. doi: 10.3390/pharmaceutics13030342.
17. Ezz A, Amoushahi A, Rashad A. Disinfection of SARS-COV-2 (COVID-19) in Human Respiratory Tract by Controlled Ethanol Vapor Inhalation combined with Asprin. J Vaccines Vaccin. 2021; 12: 454.
18. Salvatori P. The rationale of ethanol inhalation for disinfection of the respiratory tract in SARS-CoV-2-positive asymptomatic subjects. Pan African Medical Journal. 2021; 40: 201. [doi: 10.11604/pamj.2021.40.201.31211].
19. Spinner C, Gottlieb R, Criner G. Arribas Ló pez JR, Cattelan AM, Soriano Viladomiu A, et al. Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients with Moderate COVID-19: A Randomized Clinical Trial. JAMA—J Am Med Assoc. 2020; 324 (11): 1048-57.