Smoking and Influenza-associated Morbidity and Mortality

Han, Lefei; Ran, Jinjun; Mak, YW; Suen, Lorna Kwai Ping; Lee, Paul H.; Peiris, J. S. Malik; Yang, Lin

doi:10.1097/ede.0000000000000984

Cited by 79 publications

(65 citation statements)

References 71 publications

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“…Smoking history was another pedictor of FluA-p mortality in our study, which is a finding commensurate with some previous reports [34][35][36]. Wong and colleagues, for example, found that influenza-related mortality for all-causes and for cardiovascular and respiratory diseases was greater in current and exsmokers than in never smokers [34].…”

Section: Discussionsupporting

confidence: 92%

FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients

Liang

Han

et al. 2020

Respir Res

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Background: The pneumonia severity index (PSI) and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) score have been shown to predict mortality in community-acquired pneumonia. Their ability to predict influenza-related pneumonia, however, is less well-established. Methods: A total of 693 laboratory-confirmed FluA-p patients diagnosed between Jan 2013 and Dec 2018 and recruited from five teaching hospitals in China were included in the study. The sample included 494 patients in the derivation cohort and 199 patients in the validation cohort. The prediction rule was established based on independent risk factors for 30-day mortality in FluA-p patients from the derivation cohort. Results: The 30-day mortality of FluA-p patients was 19.6% (136/693). The FluA-p score was based on a multivariate logistic regression model designed to predict mortality. Results indicated the following significant predictors (regression statistics and point contributions toward total score in parentheses): blood urea nitrogen > 7 mmol/L (OR 1.604, 95% CI 1.150-4.492, p = 0.040; 1 points), pO 2 /F i O 2 ≤ 250 mmHg (OR 2.649, 95% CI 1.103-5.142, p = 0.022; 2 points), cardiovascular disease (OR 3.967, 95% CI 1.269-7.322, p < 0.001; 3 points), arterial PH < 7.35 (OR 3.959, 95% CI 1.393-7.332, p < 0.001; 3 points), smoking history (OR 5.176, 95% CI 2.604-11.838, p = 0.001; 4 points), lymphocytes < 0.8 × 10 9 /L (OR 8.391, 95% CI 3.271-16.212, p < 0.001; 5 points), and early neurominidase inhibitor therapy (OR 0.567, 95% CI 0.202-0.833, p = 0.005; − 2 points). Seven points was used as the cut-off value for mortality risk stratification. The model showed a sensitivity of 0.941, a specificity of 0.762, and overall better predictive performance than the PSI risk class (AUROC = 0.908 vs 0.560, p < 0.001) and the CURB-65 score (AUROC = 0.908 vs 0.777, p < 0.001). Conclusions: Our results showed that a FluA-p score was easy to derive and that it served as a reliable prediction rule for 30-day mortality in FluA-p patients. The score could also effectively stratify FluA-p patients into relevant risk categories and thereby help treatment providers to make more rational clinical decisions.

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Section: Discussionsupporting

confidence: 92%

FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients

Liang

Han

et al. 2020

Respir Res

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“…Smokers are 34% more likely than non-smokers to contract the flu [6]. Han and colleagues conclude that literature evidence showed that smoking was consistently associated with a higher risk of hospital admissions after influenza infection [7]. Smoking is the primary etiological factor behind chronic obstructive pulmonary disease (COPD) in the developed world, but environmental pollution and degrading air quality are also responsible in developing countries.…”

mentioning

confidence: 99%

Smoking Upregulates Angiotensin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19)

Brake

Barnsley

et al. 2020

JCM

490

453

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The epicenter of the original outbreak in China has high male smoking rates of around 50%, and early reported death rates have an emphasis on older males, therefore the likelihood of smokers being overrepresented in fatalities is high. In Iran, China, Italy, and South Korea, female smoking rates are much lower than males. Fewer females have contracted the virus. If this analysis is correct, then Indonesia would be expected to begin experiencing high rates of Covid-19 because its male smoking rate is over 60% (Tobacco Atlas). Smokers are vulnerable to respiratory viruses.Smoking can upregulate angiotensin-converting enzyme-2 (ACE2) receptor, the known receptor for both the severe acute respiratory syndrome (SARS)-coronavirus (SARS-CoV) and the human respiratory coronavirus NL638. This could also be true for new electronic smoking devices such as electronic cigarettes and "heat-not-burn" IQOS devices. ACE2 could be a novel adhesion molecule for SARS-CoV-2 causing Covid-19 and a potential therapeutic target for the prevention of fatal microbial infections, and therefore it should be fast tracked and prioritized for research and investigation. Data on smoking status should be collected on all identified cases of Covid-19.Little attention has been given to the role of smoking in either the transmission of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, actual virus) or mortality rate of Covid-19 (name of the disease caused). Smokers contract more respiratory ailments, including colds (commonly rhinoviruses, but also coronaviruses) than non-smokers. Smokers also show double the influenza rate and increased rates of bacterial pneumonia and tuberculosis [1][2][3][4][5]. The damage caused to the lungs by smoking makes patients more susceptible to pulmonary infections, both bacterial and viral [6]. Smokers are 34% more likely than non-smokers to contract the flu [6]. Han and colleagues conclude that literature evidence showed that smoking was consistently associated with a higher risk of hospital admissions after influenza infection [7]. Smoking is the primary etiological factor behind chronic obstructive pulmonary disease (COPD) in the developed world, but environmental pollution and degrading air quality are also responsible in developing countries. It is now the fourth leading cause of death in the world [8]. Vaccination against influenza is strongly recommended for patients with COPD, as the frequency and progression of exacerbations are strongly linked to respiratory viruses

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“…Previous studies have shown that current smokers are more likely to have fewer health‐conscious behaviours including receiving an influenza vaccine 22 . Furthermore, a recent meta‐analysis has demonstrated that smoking is consistently associated with a higher risk of hospital admissions after influenza infection 3 . While we have only captured a small number of smokers in our program, smokers’ understanding of influenza severity could be a potential area of intervention to improve uptake of influenza vaccines.…”

Section: Discussionmentioning

confidence: 99%

“…Certain groups within the population are identified as being at higher risk of complications related to influenza infection. They include people aged >65 years; children aged <5 years; Aboriginal and Torres Strait Islander Peoples; people with Down syndrome; pregnant women; homeless people; smokers; and those with chronic diseases and other health conditions such as cardiac disease, obesity, chronic respiratory conditions, chronic neurological conditions, immunocompromised conditions, chronic liver disease and diabetes mellitus 2,3 . While there is no unified definition of ‘hard‐to‐reach’ populations, studies exploring influenza vaccine coverage for this group have generally included ethnic minorities, immigrants and homeless people 4–6 .…”

mentioning

confidence: 99%

“…They include people aged >65 years; children aged <5 years; Aboriginal and Torres Strait Islander Peoples; people with Down syndrome; pregnant women; homeless people; smokers; and those with chronic diseases and other health conditions such as cardiac disease, obesity, chronic respiratory conditions, chronic neurological conditions, immunocompromised conditions, chronic liver disease and diabetes mellitus. 2,3 While there is no unified definition of 'hardto-reach' populations, studies exploring influenza vaccine coverage for this group have generally included ethnic minorities, immigrants and homeless people. [4][5][6] For the purpose of this study, we have defined 'hardto-reach' population as those who do not access healthcare services due to a number of factors, such as being from an ethnic minority, homeless or in financial crisis.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Factors influencing the uptake of influenza vaccine vary among different groups in the hard‐to‐reach population

Kong

Chu

Giles³

2020

Australian and New Zealand Journal of Public Health

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Objective: This report describes a mobile outreach influenza immunisation program for vulnerable populations in a resource‐rich setting. It explores vaccine recipients’ demographics, comorbidities and vaccination histories, and the factors influencing their decision to receive vaccine during outreach. Methods: Teams of nurse immunisers visited and provided influenza vaccines to clients from 21 sites (18 community centres for migrants, refugees and the homeless; and three outpatient clinics). Risk factors for severe influenza, vaccination histories and perceived barriers and facilitators to vaccines were collected from vaccine recipients. Results: A total of 1,032 vaccine recipients participated in the survey with responses collected from April to October 2018. Of these, 54% reported at least one risk factor for severe influenza. Sixty per cent of recipients had not received an influenza vaccine in 2017, with most of them reporting ‘not worried about influenza’ as a reason. Pregnant participants most frequently reported a healthcare provider’s recommendation as the reason to receive the vaccine. Conclusion: An outreach program comprising of a means of taking vaccines to the population was a successful strategy to deliver influenza vaccines to high‐risk populations. It needs to be considered in the full range of delivery models to improve influenza vaccine coverage, even in resource‐rich settings. Implication for public health: Strategies reaching out to vulnerable populations are crucial to maximise vaccine uptake.

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Smoking and Influenza-associated Morbidity and Mortality

Cited by 79 publications

References 71 publications

FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients

FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients

Smoking Upregulates Angiotensin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19)

Factors influencing the uptake of influenza vaccine vary among different groups in the hard‐to‐reach population

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