Affect of smoking on the event of COVID-19 “troublesome to handle with scientific trials”

March 05, 2021

2 min read

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Tobacco product use is a potential risk factor for worse COVID-19 outcomes, and a new paper in the Annals of the American Thoracic Society sheds light on types of research to better understand this relationship.

“The relationship between smoking and COVID-19 is complex and much of the research to date has been inconclusive or inconsistent,” said Dr. Enid Neptune, professor of medicine in the Department of Lung and Intensive Care Medicine at Johns Hopkins University issued a related press release. “To solve this problem, a rigorous study design is required. This research should accurately confirm smoke exposure, with indicators that distinguish infection from disease and provide an objective assessment of confounders. “

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There is currently evidence of an association between tobacco use and a higher incidence of worse clinical COVID-19 outcomes and mortality, with current smokers at an increased risk of hospital death compared to non-smokers. In the OPENsafely study, smokers and ex-smokers in the UK were at an increased risk of (25% and 80%, respectively) compared to non-smokers. In addition, recent data suggests that e-cigarette use may be linked to a five-fold increased chance of a positive diagnosis of COVID-19.

Neptune and Michelle N. Eakin, PhD, Associate Professor of Medicine in the Department of Lung and Intensive Care Medicine at Johns Hopkins University, highlighted several topics to be addressed in future research on the relationship between smoking and COVID-19, including the respiratory tract / Airspace injuries, inflammation profiles that support virus pathogenesis, disorders of renin-angiotensin signal transmission and nicotine signaling and their relationship to SARS-CoV-2 infections and diseases.

According to Neptune and Eakin, it is important to describe the effects of tobacco smoke on nasal tissues caused by the penetration of SARS-CoV-2 through the nasal airways. Few research has been done to date on the effects of smoking on these specific airways. Research has shown that smoking affects a person’s ability to respond to a respiratory virus. However, it’s important to investigate whether smoking contributes to this inability or affects a person’s inflammatory response to viruses like SARS-CoV-2, the authors say.

Because renin angiotensin proteins control intracellular pathways that affect lung health, some evidence suggests that disruption of these proteins may protect people with COPD from lung injury from cigarette smoking. However, it is not yet known if this applies to people with COVID-19 infection.

Finally, the authors discussed results suggesting that nicotine exposure and signaling may reduce SARS-CoV-2 infection and disease. Therefore, the effects of nicotine and smoking should be investigated as, according to Neptun and Eakin, nicotine-delivering e-cigarettes are more widely used.

Other research has focused on whether smoking affects the lung’s angiotensin converting enzyme 2, but more research is needed on how and whether tobacco smoke and nicotine affect SARS-CoV-2 infectivity or viral load, according to the authors, to create a context for this research.

To understand the relationship between smoking and COVID-19 pathogenesis, Neptune and Eakin developed three goals for future research:

• extensive population health epidemiological data, including clear metrics for assessing smoking status;
• preclinical research modeling of relevant aspects of cigarette smoke exposure and SARS-CoV-2 infection to understand mechanisms that contribute to disease development and morbidity; and
• Mechanistic parsing of nicotine release in the lungs to define key paracrine and autocrine interactions between nicotine signaling and virus binding and processing.

In addition, including smoke and steam status in COVID-19 vaccine studies could benefit data on infection rates from exposure to tobacco products, Neptune said.

“Our paper shows that the effects of tobacco exposure on the evolution of COVID-19 are difficult to manage with clinical trials and require rigorous validation with cell and animal studies,” said Neptune. “Overall, the multiple published studies on smoking and COVID have not yet solved the problem. Our intention in publishing this paper is to identify the interpretative challenges of the overall dataset and recommend ways for the future. “

Reference:
Press release.

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