When Vodka Was a Breathing Treatment for Heart Failure

Today, respiratory therapists treat pulmonary edema with CPAP, BiPAP, and diuretics like Lasix. But there was a time—especially in the early to mid-20th century—when another, more surprising remedy was used: alcohol. And not just ingested alcohol, but inhaled alcohol—sometimes even vodka—administered as a breathing treatment.

Why Alcohol?

In cases of acute heart failure, fluid backs up into the lungs, leading to pulmonary edema. This can cause the patient to froth at the mouth—literally—as fluid mixes with air in the alveoli and upper airways, creating a white, foamy sputum.

Alcohol, especially ethanol, is a known anti-foaming agent. When nebulized and inhaled, it reduces surface tension in the foam, essentially collapsing the bubbles. This makes breathing easier by improving gas exchange and reducing the pink frothy sputum that characterizes severe pulmonary edema.

How It Was Used

In the 1920s through the 1950s, nebulized ethanol (typically 30-50%) was commonly given via facemask or oxygen tent. When hospitals lacked pharmaceutical-grade alcohol, staff sometimes used vodka or gin as a substitute—whatever was on hand that contained a high enough proof to work. There are even anecdotes of vodka being poured directly into the endotracheal tube (ETT) in emergency situations.

Respiratory therapists (then often called inhalation therapists) or nurses would add alcohol to a nebulizer, often connected to humidified oxygen. The mist was inhaled by the patient, calming the froth within minutes. It was a low-tech but effective intervention at the time.

When Did It Fall Out of Favor?

The use of inhaled alcohol declined sharply in the 1960s and 70s as better pharmacologic treatments for heart failure became available. Furosemide (Lasix) was introduced in 1966, providing a fast and reliable diuretic effect that removed fluid at its source. Positive pressure ventilation also became more common, offering mechanical support to improve oxygenation.

Eventually, studies raised concerns about potential complications of inhaling alcohol—like mucosal irritation, systemic absorption, and delayed clearing of secretions. As more effective and safer treatments became standard, alcohol nebulization was abandoned.

Still in the Literature

Although rare, you may still see inhaled alcohol mentioned in older nursing or respiratory therapy textbooks and journals. It's one of those fascinating chapters in medical history—a time when we used what we had, and sometimes, what we had was vodka.

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Sources:

• Donnelly WH. "Nebulized Ethyl Alcohol in Pulmonary Edema." JAMA. 1946.

• Pinsky MR. "Historical Perspectives on Pulmonary Edema Management." Chest. 2004.

• Furosemide FDA approval: U.S. National Library of Medicine, 1966.

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