Controversy over smoking in COVID‐19—A real world experience in New York city

Abstract

Data are conflicting regarding the impact of tobacco smoking in people with pneumonia due to SARS-CoV-2 infection . We performed a retrospective multicentre cohort study of 9991 consecutive patients hospitalized in a major New York academic center between March 7th and June 5th, 2020 with laboratory-confirmed COVID-19. The clinical outcomes assessed included risk of hospitalization, in-hospital mortality, risk of intensive care unit (ICU) admission, and need for mechanical ventilation among smokers (current and former). Multivariable logistic regression and propensity score models were built to adjust for potential confounders. Among 9991 consecutive patients diagnosed with COVID-19, 2212 (22.1%) patients were self-reported smokers (406 current and 1806 former).Current smoking was not associated with an increased risk of hospitalization (propensity score [PS]-adjusted OR 0.91; p = .46), in-hospital mortality (PS-OR 0.77; p = .12), ICU admission (PS-OR 1.18; p = .37), or intubation (PS-OR 1.04; p = .85).Similarly, former smoking was not associated with an increased risk of hospitalization (PS-OR 0.88; p = .11), in-hospital mortality (PS-OR 1.03; p = .78), ICU admission (PS-OR 1.03; p = .95), or intubation (PS-OR 0.93; p = .57). Furthermore, smoking (current or former) was not associated with an increased risk of hospitalization (PS-OR 0.85; p = .05), in-hospital mortality (PS-OR 0.94; p = .49), ICU admission (PS-OR 0.86; p = .17), or intubation (PS-OR 0.79; p = .06). Smoking is a well-known risk factor associated with greater susceptibility and subsequent increased severity of respiratory infections. In the current COVID-19 pandemic, smokers may have increased risk and severe pneumonia. In the current COVID-19 pandemic, smokers are believed to have an increased risk of mortality as well as severe pneumonia. However, in our analysis of real-world clinical data, smoking was not associated with increased in-patient mortality in COVID-19 pneumonia, in accordance with prior reports.

Chemosensory dysfunction, tobacco smoking and the need of hospitalization: how do they relate? - Data from COVID_19 patients in Northwestern Greece

“…Except this low percentage, we found that tobacco smoking was statistically significant associated with decreased risk of ICU admission. Our results find support to Julia Hippisley-Cox study [50] and all previous reposted studies [46][47][48].…”

“…However, this assertion is much more an expectation rather than real-world data [45]. A China study found that the smoking prevalence among COVID-19 patients was 10.2%, [46], following the low prevalence of current smokers among hospitalized COVID-19 that is a common finding across several countries [46][47][48][49].…”

The Impact of Tobacco Use on COVID-19 Outcomes: A Systematic Review

“…Even with an initial pool of 100 smokers, some studies only observed 2 or 3 deaths within that group, making statistical analysis difficult. Some of the studies that did not find a significant association in multivariable analysis found increased mortality risk in univariate analysis [ 18 , 24 ].…”

Angiotensin Converting Enzyme 2 Expression in Human Type II Pneumocytes is Influenced by Renin-Angiotensin System Blockade

“…Purkayastha and colleagues, through modeling the direct effects of cigarette smoke on SARS-CoV-2 infection, showed that acute cigarette smoke exposure increases the number of infected and apoptotic cells, prevents the normal airway basal stem cell repair response, suggesting that smoke increases COVID-19 severity 39 . However, it has been shown that smoking was not associated with increased mortality in COVID-19 pneumonia 40,41 , but cumulative smoking exposure, as measured by pack/years, was associated with a higher risk of hospitalization and mortality from COVID-19 in a dose-dependent manner 42 . In contrast, cigarette smoke-pretreatment potently abrogates SARS-CoV-2 replication in an vitro model 34 .…”