Smoking or Vaping Increases COVID-19 Risks


These poor health choices can lead to disease progression, even among younger people, for those who have the coronavirus.

Although patients over age 65 years are most at risk for severe complications related to COVID-19, data show that about 20% of deaths were within the 20-to-64 age group, which is higher than originally expected, and smoking and vaping can worsen the disease.1,2

Person-to-person spread of COVID-19 has occurred throughout the world.3Coughing, fever, and shortness of breath are the hallmark symptoms noted in the majority of patients.4COVID-19 affects the lower respiratory tract, so those patients with chronic cardiovascular and lung disease are at high risk for complications of the disease.

Smoking and vaping have been shown to lead to chronic lung disease, such as chronic obstructive pulmonary disease.5In 2018, 7.6% of adults aged 18 to 24 and 4.2% of adults aged 25 to 44 used e-cigarettes daily.6This past fall and summer saw an outbreak of respiratory disease in the United States associated with e-cigarette or vaping product use. Vitamin E acetate was found to be one of the offending additives that cause alveoli thickening and exudate production in these patients’ lungs.7Vaporized e-cigarette fluid and smoke from conventional cigarettes are cytotoxic, pro-inflammatory, and inhibit phagocytosis in alveolar macrophages. Detection and phagocytosis of pathogens is a primary function of alveolar macrophages. It is usually these cells that initiate an immune response to infection in the airways. Therefore, any reduction in phagocytosis from cigarette smoke or e-cigarette vapor can decrease individuals’ innate immune response.5,8That means that it is not much of a stretch to hypothesize that patients who smoke and/or vape may have more serious consequences from COVID-19 than patients who do not smoke and/or vape.8

With more fatalities in the 20-to-64-year-old age group from COVID-19 than originally expected, more studies are needed to look at a connection between smoking and/or vaping and the risk of severe illness from COVID-19. One study has been released from China analyzing the factors associated with COVID-19 disease outcomes. The study results showed that the proportion of patients with a history of smoking was significantly higher in the “progression” group (patients that advanced with more serious complications of the disease) than the “improvement/stabilization” group (patients with mild to moderate symptoms of the disease). This suggests that smoking is associated with disease progression.9

As the world grapples with this disease and attempts to contain it, all health care providers should discuss smoking cessation with patients who smoke or vape and the additional threat that COVID-19 poses for them.

Bethany Rettberg, NPC, is a family nurse practitioner at CVS MinuteClinic in Mokena, Illinois.


1. CDC Covid-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) — United States, February 12-March 16, 2020.MMWR Morb Wkly Rep.2020:69(12):343-346. doi. 10.15585/mmwr.mm6912e2.

2. Remaly J. 20% of UC COVID-19 deaths were aged 20-64.Medscape.March 19, Accessed March 27, 2020.

3. CDC. Coronavirus disease 2019 (COVID-19): situation Updated March 21, 2020. Accessed March 27, 2020.

4. Coronavirus disease 2019 (COVID-19): symptoms of Updated March 20, 2020. Accessed March 27, 2020.

5. Scott A. Lugg ST, Aldridge K, et al. Pro-inflammatory effects of e-cigarette vapour condensate on human alveolar macrophages.Thorax.2018;73(12):1161-1169. doi: 10.1136/thoraxjnl-2018-211663.

6. E-cigarettes: facts, stats and regulations. Truth Initiative Published November 11, 2019. Accessed March 27, 2020.

7. Layden JE, Ghinai I, Pray I, et al. Pulmonary illness related to e-cigarette use in Illinois and Wisconsin - final report.N Engl J Med.2020;382(10):903-916. doi: 10.1056/NEJMoa1911614.

8. Lewis T. Smoking or vaping may increase the risk of a severe coronavirus infection.Scientific American.March 17, March 27, 2020.

9. Liu W, Tao ZW, Wei L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease.Chin Medical J (Engl).2020. doi: 10.1097/CM9.0000000000000775.

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