Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis

Abstract

Aim To summarise and quantify the effect of tobacco smoking on the risk of developing community acquired pneumonia (CAP) in adults. Methods We systematically searched MEDLINE, Embase, CINAHL, PsychINFO and Web of Science, from inception to October 2017, to identify case-control and cohort studies and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The review protocol was registered with the PROSPERO database (CRD42018093943). Study quality was assessed by the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) or hazard ratios (HRs) were estimated using a random-effects model. Results Of 647 studies identified, 27 studies were included (n = 460,592 participants) in the systematic review. Most of the included studies were of moderate quality with a median score of six (IQR 6–7). Meta-analysis showed that current smokers (pooled OR 2.17, 95% CI 1.70–2.76, n = 13 studies; pooled HR 1.52, 95% CI 1.13–2.04, n = 7 studies) and ex-smokers (pooled OR 1.49, 95% CI 1.26–1.75, n = 8 studies; pooled HR 1.18, 95% CI 0.91–1.52, n = 6 studies) were more likely to develop CAP compared to never smokers. Although the association between passive smoking and risk of CAP in adults of all ages was not statistically significant (pooled OR 1.13, 95% CI 0.94–1.36, n = 5 studies), passive smoking in adults aged ≥65 years was associated with a 64% increased risk of CAP (pooled OR 1.64; 95% CI 1.17–2.30, n = 2 studies). Dose-response analyses of data from five studies revealed a significant trend; current smokers who smoked higher amount of tobacco had a higher risk of CAP. Conclusion Tobacco smoke exposure is significantly associated with the development of CAP in current smokers and ex-smokers. Adults aged > 65 years who are passive smokers are also at higher risk of CAP. For current smokers, a significant dose-response relationship is evident.

Defining Community-Acquired Pneumonia as a Public Health Threat: Arguments in Favor from Spanish Investigators

“…In the CAP population, smoking increases the risk of 30-day mortality independently of tobacco-related comorbidity and age. A recently published systematic review reported that tobacco smoke exposure is significantly associated with the development of CAP in both current and ex-smokers and that passive smokers aged >65 years are at higher risk of CAP [71].…”

Active smoking is associated with severity of coronavirus disease 2019 (COVID-19 ): An update of a meta-analysis

“…A recent meta-analysis including 7 studies also revealed that smokers have a double risk of severe COVID-19 (pooled OR=1.98; 95% CI: 1.29-3.05) 8 . A meta-analysis published in 2019 including 27 studies and 460592 participants revealed current smokers (pooled OR=2.17; 95% CI: 1.70-2.76) and ex-smokers (pooled OR=1.49; 95% CI: 1.26-1.75) were more likely to develop community-acquired pneumonia compared to never smokers 9 . The evidence suggests that smokers are more vulnerable to lung infection, and COVID-19 is no exception.…”

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia

“…34 In the case of all-cause CAP, a recent systematic review and meta-analysis, encompassing 27 studies and 460,592 participants, revealed that current smokers have a significantly increased risk for development of CAP relative to never-smokers (OR 2.17; 95% CI, 1.70-2.76, n ¼ 13 studies). 35 Passive smoking is associated with a 64% increase in the risk for development of CAP, but only for those aged >65 years (OR 1.64; 95% CI, 1.17-2.30, n ¼ 2 studies). 35 Smoking-related increased susceptibility for development of severe pneumococcal disease has generally been attributed to cigarette smoke-mediated suppression of innate and adaptive pulmonary host defenses.…”

“…35 Passive smoking is associated with a 64% increase in the risk for development of CAP, but only for those aged >65 years (OR 1.64; 95% CI, 1.17-2.30, n ¼ 2 studies). 35 Smoking-related increased susceptibility for development of severe pneumococcal disease has generally been attributed to cigarette smoke-mediated suppression of innate and adaptive pulmonary host defenses. 36 Our research findings, some very recent, have, however, revealed additional pathogentargeted mechanisms that are likely to contribute to smoking-related susceptibility for development of severe pneumococcal disease.…”