Smoking history is an important risk factor for severe COVID-19


Giuseppe Gorini, Luke Clancy, Esteve Fernandez and Silvano Gallus

Current evidence suggests that an association exists between smoking and COVID-19 severity, in line with recent research which has shown that smoking is associated with increased risk of acute respiratory distress syndrome. Moreover, a study based on 1099 COVID-19 patients showed that 31.7% of patients with a smoking history had severe COVID-19 disease at the time of hospital admission, compared to 14.5% among never-smokers; crude odds ratio (OR): 1.87 (95% CI: 1.21-2.86). Likewise, 16.2% of patients with smoking history recorded a primary end-point event (i.e., admission to the intensive care unit, use of mechanical ventilation or death), compared to 4.7% among never-smokers; OR: 3.25 (95% CI: 1.79-5.73).

These data are in line with a study based on 78 patients with COVID-19 pneumonia which showed 27.3% of ever-smokers did not improve after 2 weeks, compared to 3.0% among never-smokers. In multivariate analysis, smoking history recorded the highest OR (14.29; 95% CI: 1.58-25.00).

In conclusion, although smoking might not be related to COVID-19 incidence, in the absence of more data, tobacco smoking appears to be the most important avoidable risk factor for a poorer prognosis in COVID-19. Smoking status should be recorded in all surveillance systems for COVID-19 in every country. We concur with the recommendation to quit smoking to avoid complications in case of COVID-19 infection. In line with this, now is the time to make Smoking Cessation Services available free of charge in every country capable of delivering such a service.

  • More by Luke Clancy: Do you smoke or vape? Here’s why Covid-19 means you should quit right now (Irish Times) click here

Giuseppe Gorini is with the Oncologic Network, Prevention and Iesearch Institute (ISPRO), Florence, Italy.  Luke Clancy is Director of TobaccoFree Research Institute Ireland, Dublin, Ireland. Esteve Fernandez is with the Institut Català d’Oncologia (ICO), Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (UB) and CIBER Respiratory Diseases, Spain. Silvano Gallus is with the Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.

The Authors declare no conflicts of interest. Correspondence:

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