diff --git a/homeassistant/auth/providers/command_line.py b/homeassistant/auth/providers/command_line.py
index 92d8d617481..f63d6d465f6 100644
--- a/homeassistant/auth/providers/command_line.py
+++ b/homeassistant/auth/providers/command_line.py
@@ -68,6 +68,7 @@ class CommandLineAuthProvider(AuthProvider):
                 *self.config[CONF_ARGS],
                 env=env,
                 stdout=asyncio.subprocess.PIPE if self.config[CONF_META] else None,
+                close_fds=False,  # required for posix_spawn
             )
             stdout, _ = await process.communicate()
         except OSError as err:
diff --git a/homeassistant/components/command_line/__init__.py b/homeassistant/components/command_line/__init__.py
index 172c321c0ec..c0713d0780b 100644
--- a/homeassistant/components/command_line/__init__.py
+++ b/homeassistant/components/command_line/__init__.py
@@ -18,7 +18,10 @@ def call_shell_with_timeout(
     try:
         _LOGGER.debug("Running command: %s", command)
         subprocess.check_output(
-            command, shell=True, timeout=timeout  # nosec # shell by design
+            command,
+            shell=True,  # nosec # shell by design
+            timeout=timeout,
+            close_fds=False,  # required for posix_spawn
         )
         return 0
     except subprocess.CalledProcessError as proc_exception:
@@ -41,7 +44,10 @@ def check_output_or_log(command: str, timeout: int) -> str | None:
     """Run a shell command with a timeout and return the output."""
     try:
         return_value = subprocess.check_output(
-            command, shell=True, timeout=timeout  # nosec # shell by design
+            command,
+            shell=True,  # nosec # shell by design
+            timeout=timeout,
+            close_fds=False,  # required for posix_spawn
         )
         return return_value.strip().decode("utf-8")
     except subprocess.CalledProcessError as err:
diff --git a/homeassistant/components/command_line/notify.py b/homeassistant/components/command_line/notify.py
index 7bce5010d45..c41e26c21bb 100644
--- a/homeassistant/components/command_line/notify.py
+++ b/homeassistant/components/command_line/notify.py
@@ -52,6 +52,7 @@ class CommandLineNotificationService(BaseNotificationService):
             self.command,
             universal_newlines=True,
             stdin=subprocess.PIPE,
+            close_fds=False,  # required for posix_spawn
             shell=True,  # nosec # shell by design
         ) as proc:
             try:
diff --git a/homeassistant/components/ping/binary_sensor.py b/homeassistant/components/ping/binary_sensor.py
index ff662b55a93..7500d9988af 100644
--- a/homeassistant/components/ping/binary_sensor.py
+++ b/homeassistant/components/ping/binary_sensor.py
@@ -227,6 +227,7 @@ class PingDataSubProcess(PingData):
             stdin=None,
             stdout=asyncio.subprocess.PIPE,
             stderr=asyncio.subprocess.PIPE,
+            close_fds=False,  # required for posix_spawn
         )
         try:
             out_data, out_error = await asyncio.wait_for(
diff --git a/homeassistant/components/ping/device_tracker.py b/homeassistant/components/ping/device_tracker.py
index c3729f04c14..68111df89ea 100644
--- a/homeassistant/components/ping/device_tracker.py
+++ b/homeassistant/components/ping/device_tracker.py
@@ -55,7 +55,10 @@ class HostSubProcess:
     def ping(self):
         """Send an ICMP echo request and return True if success."""
         with subprocess.Popen(
-            self._ping_cmd, stdout=subprocess.PIPE, stderr=subprocess.DEVNULL
+            self._ping_cmd,
+            stdout=subprocess.PIPE,
+            stderr=subprocess.DEVNULL,
+            close_fds=False,  # required for posix_spawn
         ) as pinger:
             try:
                 pinger.communicate(timeout=1 + PING_TIMEOUT)
diff --git a/homeassistant/components/rpi_camera/camera.py b/homeassistant/components/rpi_camera/camera.py
index 59ce8fee5f9..3f9b5fd5860 100644
--- a/homeassistant/components/rpi_camera/camera.py
+++ b/homeassistant/components/rpi_camera/camera.py
@@ -32,7 +32,10 @@ _LOGGER = logging.getLogger(__name__)
 def kill_raspistill(*args):
     """Kill any previously running raspistill process.."""
     with subprocess.Popen(
-        ["killall", "raspistill"], stdout=subprocess.DEVNULL, stderr=subprocess.STDOUT
+        ["killall", "raspistill"],
+        stdout=subprocess.DEVNULL,
+        stderr=subprocess.STDOUT,
+        close_fds=False,  # required for posix_spawn
     ):
         pass
 
@@ -132,7 +135,10 @@ class RaspberryCamera(Camera):
         # Therefore it must not be wrapped with "with", since that
         # waits for the subprocess to exit before continuing.
         subprocess.Popen(  # pylint: disable=consider-using-with
-            cmd_args, stdout=subprocess.DEVNULL, stderr=subprocess.STDOUT
+            cmd_args,
+            stdout=subprocess.DEVNULL,
+            stderr=subprocess.STDOUT,
+            close_fds=False,  # required for posix_spawn
         )
 
     def camera_image(
diff --git a/homeassistant/components/seven_segments/image_processing.py b/homeassistant/components/seven_segments/image_processing.py
index b6accf30de8..58d532f58f8 100644
--- a/homeassistant/components/seven_segments/image_processing.py
+++ b/homeassistant/components/seven_segments/image_processing.py
@@ -130,7 +130,10 @@ class ImageProcessingSsocr(ImageProcessingEntity):
         img.save(self.filepath, "png")
 
         with subprocess.Popen(
-            self._command, stdout=subprocess.PIPE, stderr=subprocess.PIPE
+            self._command,
+            stdout=subprocess.PIPE,
+            stderr=subprocess.PIPE,
+            close_fds=False,  # Required for posix_spawn
         ) as ocr:
             out = ocr.communicate()
             if out[0] != b"":
diff --git a/homeassistant/components/shell_command/__init__.py b/homeassistant/components/shell_command/__init__.py
index d4a0a3ac1d5..cade4eaff68 100644
--- a/homeassistant/components/shell_command/__init__.py
+++ b/homeassistant/components/shell_command/__init__.py
@@ -65,6 +65,7 @@ async def async_setup(hass: HomeAssistant, config: ConfigType) -> bool:
                 stdin=None,
                 stdout=asyncio.subprocess.PIPE,
                 stderr=asyncio.subprocess.PIPE,
+                close_fds=False,  # required for posix_spawn
             )
         else:
             # Template used. Break into list and use create_subprocess_exec
@@ -76,6 +77,7 @@ async def async_setup(hass: HomeAssistant, config: ConfigType) -> bool:
                 stdin=None,
                 stdout=asyncio.subprocess.PIPE,
                 stderr=asyncio.subprocess.PIPE,
+                close_fds=False,  # required for posix_spawn
             )
 
         process = await create_process
diff --git a/homeassistant/runner.py b/homeassistant/runner.py
index d3c2633bc7b..8c5766cbb2b 100644
--- a/homeassistant/runner.py
+++ b/homeassistant/runner.py
@@ -6,6 +6,7 @@ from asyncio import events
 import dataclasses
 import logging
 import os
+import subprocess
 import threading
 import traceback
 from typing import Any
@@ -28,6 +29,7 @@ from .util.thread import deadlock_safe_shutdown
 #
 MAX_EXECUTOR_WORKERS = 64
 TASK_CANCELATION_TIMEOUT = 5
+ALPINE_RELEASE_FILE = "/etc/alpine-release"
 
 _LOGGER = logging.getLogger(__name__)
 
@@ -153,8 +155,22 @@ async def setup_and_run_hass(runtime_config: RuntimeConfig) -> int:
     return await hass.async_run()
 
 
+def _enable_posix_spawn() -> None:
+    """Enable posix_spawn on Alpine Linux."""
+    # pylint: disable=protected-access
+    if subprocess._USE_POSIX_SPAWN:
+        return
+
+    # The subprocess module does not know about Alpine Linux/musl
+    # and will use fork() instead of posix_spawn() which significantly
+    # less efficient. This is a workaround to force posix_spawn()
+    # on Alpine Linux which is supported by musl.
+    subprocess._USE_POSIX_SPAWN = os.path.exists(ALPINE_RELEASE_FILE)
+
+
 def run(runtime_config: RuntimeConfig) -> int:
     """Run Home Assistant."""
+    _enable_posix_spawn()
     asyncio.set_event_loop_policy(HassEventLoopPolicy(runtime_config.debug))
     # Backport of cpython 3.9 asyncio.run with a _cancel_all_tasks that times out
     loop = asyncio.new_event_loop()
diff --git a/homeassistant/util/package.py b/homeassistant/util/package.py
index b67e9923b9c..c2c84bf855d 100644
--- a/homeassistant/util/package.py
+++ b/homeassistant/util/package.py
@@ -94,7 +94,14 @@ def install_package(
         args += ["--user"]
         env["PYTHONUSERBASE"] = os.path.abspath(target)
     _LOGGER.debug("Running pip command: args=%s", args)
-    with Popen(args, stdin=PIPE, stdout=PIPE, stderr=PIPE, env=env) as process:
+    with Popen(
+        args,
+        stdin=PIPE,
+        stdout=PIPE,
+        stderr=PIPE,
+        env=env,
+        close_fds=False,  # required for posix_spawn
+    ) as process:
         _, stderr = process.communicate()
         if process.returncode != 0:
             _LOGGER.error(
@@ -121,6 +128,7 @@ async def async_get_user_site(deps_dir: str) -> str:
         stdout=asyncio.subprocess.PIPE,
         stderr=asyncio.subprocess.DEVNULL,
         env=env,
+        close_fds=False,  # required for posix_spawn
     )
     stdout, _ = await process.communicate()
     lib_dir = stdout.decode().strip()
diff --git a/tests/components/command_line/test_cover.py b/tests/components/command_line/test_cover.py
index 8940f9d959f..220da18409c 100644
--- a/tests/components/command_line/test_cover.py
+++ b/tests/components/command_line/test_cover.py
@@ -73,7 +73,10 @@ async def test_poll_when_cover_has_command_state(hass: HomeAssistant) -> None:
         async_fire_time_changed(hass, dt_util.utcnow() + SCAN_INTERVAL)
         await hass.async_block_till_done()
         check_output.assert_called_once_with(
-            "echo state", shell=True, timeout=15  # nosec # shell by design
+            "echo state",
+            shell=True,  # nosec # shell by design
+            timeout=15,
+            close_fds=False,
         )
 
 
diff --git a/tests/components/command_line/test_sensor.py b/tests/components/command_line/test_sensor.py
index 0d86b3fe7f0..c67e97ef81a 100644
--- a/tests/components/command_line/test_sensor.py
+++ b/tests/components/command_line/test_sensor.py
@@ -97,6 +97,7 @@ async def test_template_render_with_quote(hass: HomeAssistant) -> None:
             'echo "template_value" "3 4"',
             shell=True,  # nosec # shell by design
             timeout=15,
+            close_fds=False,
         )
 
 
diff --git a/tests/test_runner.py b/tests/test_runner.py
index 31e5e208cad..11a55031493 100644
--- a/tests/test_runner.py
+++ b/tests/test_runner.py
@@ -137,3 +137,22 @@ async def test_unhandled_exception_traceback(hass, caplog):
     assert "Task exception was never retrieved" in caplog.text
     assert "This is unhandled" in caplog.text
     assert "_unhandled_exception" in caplog.text
+
+
+def test__enable_posix_spawn():
+    """Test that we can enable posix_spawn on Alpine."""
+
+    def _mock_alpine_exists(path):
+        return path == "/etc/alpine-release"
+
+    with patch.object(runner.subprocess, "_USE_POSIX_SPAWN", False), patch.object(
+        runner.os.path, "exists", _mock_alpine_exists
+    ):
+        runner._enable_posix_spawn()
+        assert runner.subprocess._USE_POSIX_SPAWN is True
+
+    with patch.object(runner.subprocess, "_USE_POSIX_SPAWN", False), patch.object(
+        runner.os.path, "exists", return_value=False
+    ):
+        runner._enable_posix_spawn()
+        assert runner.subprocess._USE_POSIX_SPAWN is False
diff --git a/tests/util/test_package.py b/tests/util/test_package.py
index 2c0b4dc2e55..7c9ecdd75fe 100644
--- a/tests/util/test_package.py
+++ b/tests/util/test_package.py
@@ -95,6 +95,7 @@ def test_install(mock_sys, mock_popen, mock_env_copy, mock_venv):
         stdout=PIPE,
         stderr=PIPE,
         env=env,
+        close_fds=False,
     )
     assert mock_popen.return_value.communicate.call_count == 1
 
@@ -118,6 +119,7 @@ def test_install_upgrade(mock_sys, mock_popen, mock_env_copy, mock_venv):
         stdout=PIPE,
         stderr=PIPE,
         env=env,
+        close_fds=False,
     )
     assert mock_popen.return_value.communicate.call_count == 1
 
@@ -142,7 +144,7 @@ def test_install_target(mock_sys, mock_popen, mock_env_copy, mock_venv):
     assert package.install_package(TEST_NEW_REQ, False, target=target)
     assert mock_popen.call_count == 2
     assert mock_popen.mock_calls[0] == call(
-        args, stdin=PIPE, stdout=PIPE, stderr=PIPE, env=env
+        args, stdin=PIPE, stdout=PIPE, stderr=PIPE, env=env, close_fds=False
     )
     assert mock_popen.return_value.communicate.call_count == 1
 
@@ -185,6 +187,7 @@ def test_install_constraint(mock_sys, mock_popen, mock_env_copy, mock_venv):
         stdout=PIPE,
         stderr=PIPE,
         env=env,
+        close_fds=False,
     )
     assert mock_popen.return_value.communicate.call_count == 1
 
@@ -211,6 +214,7 @@ def test_install_find_links(mock_sys, mock_popen, mock_env_copy, mock_venv):
         stdout=PIPE,
         stderr=PIPE,
         env=env,
+        close_fds=False,
     )
     assert mock_popen.return_value.communicate.call_count == 1
 
@@ -233,6 +237,7 @@ async def test_async_get_user_site(mock_env_copy):
         stdout=asyncio.subprocess.PIPE,
         stderr=asyncio.subprocess.DEVNULL,
         env=env,
+        close_fds=False,
     )
     assert ret == os.path.join(deps_dir, "lib_dir")