Findings from Second-Largest COVID Study in US
Among current smokers hospitalized with COVID-19, prescriptions for nicotine patches, lozenges, or gum were associated with reduced mortality.
“Smoking remains the leading preventable cause of disease and death in the nation,” said co-author Dr. Michael Fiore of the University of Wisconsin, “even during the pandemic. If you smoke, getting FDA-approved medications to quit can save your life long-term. But if you have COVID, it may save your life more immediately.”
The findings, published in Nicotine & Tobacco Research, were led by researchers from the University of Wisconsin and included 104,590 hospitalized patients at 21 health systems across the United States. In this sample of hospitalized patients who were diagnosed with COVID-19 from February 1, 2020 through September 30, 2021: 7,764 were current smokers, 33,101 were former smokers, and 57,454 had never smoked. About a quarter of current smokers were prescribed nicotine replacement therapy (NRT) in the hospital. Of the smokers prescribed NRT, 4.5% died, a significantly lower rate of mortality compared to 7.7% observed in smokers who did not receive NRT.
“Several hypotheses have been forwarded regarding a possible mitigating effect of nicotine on COVID-19 outcomes,” said lead author Dr. Thomas Piasecki of the University of Wisconsin. “Nicotine may activate various anti-inflammatory mechanisms that might help protect against progression to severe disease. But it is critically important to note that the current, observational findings cannot establish a causal effect of this medication. It could also be that patients with less severe acute illness were more likely to receive medication to quit smoking. Randomized clinical trials are needed to rigorously determine whether nicotine reduces COVID-19 mortality. Our findings suggest such studies are worth pursuing.”
In general, smoking status gave little indication as to the severity of outcomes from COVID-19, even when adjusted for other factors such as age and pre-existing health conditions.
“That’s a bit surprising, given that we know smoking is associated with increased risk for respiratory infections,” Piasecki said, “but it is consistent with findings from some other large COVID-19 cohort studies.”
Vaccination against COVID-19 was protective against death for all groups in the study, but the protective effects of vaccination were especially pronounced in current and former smokers.
“Given the amount of deaths caused by smoking and COVID-19,” Fiore said, “The message is clear: Don’t smoke. And, if you do and you get COVID-19, ask your doctor about getting the nicotine gum, lozenge, or patch both to help you quit smoking and to possibly reduce your risk of death from COVID-19. Finally, get vaccinated. This is particularly important for current and former smokers.”
Contact: Chris Hollenback, University of Wisconsin, 608-417-9047 or ch3 (at) ctri.wisc.edu