Infectious Disease

Smoking can enhance the chance of creating symptomatic COVID-19

January 21, 2021

2 min read

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Disclosure:
Hopkinson is the Chair of Smoking and Health Action and Medical Director of the British Lung Foundation. In the study you will find all relevant financial information from all other authors.

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Current smoking appears to increase an individual’s risk of developing symptomatic COVID-19, as published in Thorax.

“Tobacco smoking is a major risk factor for viral and bacterial respiratory infections, with smokers five times more likely to get influenza and twice as likely to get pneumonia,” said Nicholas S. Hopkinson, PhD, Volunteer Respiratory Advisor and Clinical Director for COPD Royal Brompton Hospital in London and as Medical Director of the British Lung Foundation, and colleagues wrote. “It can therefore be an important factor worsening the effects of SARS-CoV-2.”

Researchers conducted a large prospective population cohort study that included data on 2,401,982 participants in the United Kingdom (mean age 43.6 years; 63.3% women), using the COVID-19 Symptom Study app (Zoe Global ) used. Anthropometry, smoking status and health conditions were obtained. Those who said they did not feel physically normal were asked by the app to answer questions about COVID-19 symptoms and hospitalization.

The primary outcome was the development of the classic triad of COVID-19 symptoms, including fever, recent persistent cough, and shortness of breath, and the association of these symptoms with smoking.

35 percent of participants said they felt uncomfortable and reported one or more classic symptoms of COVID-19. Current smokers were more likely to report symptoms suggestive of a diagnosis of COVID-19. The researchers reported an adjusted OR of 1.14 for classic COVID-19 symptoms (95% CI, 1.1-1.18), an aOR of 1.29 for more than five symptoms (95% CI, 1, 26-1.31) and an aOR of 1.5 for more than 10 symptoms (95% CI, 1.42-1.58).

“The pattern of associations between reported symptoms did not vary between smokers and nonsmokers, suggesting that the results cannot be explained by pre-existing smoking-related symptoms,” the researchers wrote.

The smoking rate was 7.4% in people who tested positive for SARS-CoV-2, compared to 9.3% in people who tested negative. However, smokers who tested positive had a higher symptom burden than non-smokers (OR for those with> 10 symptoms = 1.42; 95% CI, 1.09-1.83). Current smokers who tested positive had an increased risk of hospitalization compared to non-smokers (OR = 2.11; 95% CI, 1.41-3.11).

According to the researchers, these results provide evidence of the inclusion of smoking cessation and other efforts in public health campaigns to combat the COVID-19 pandemic.

“Evidence that current smoking appears to increase the exposure to COVID-19 for the individual, and therefore the health system, is a strong argument for governments to accelerate rather than disrupt action to implement tobacco control plans,” the researchers wrote. “This should include options such as polluter levies on transnational tobacco companies, as these remain highly profitable and extremely harmful to global health due to the pandemic.”

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