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?:abstract
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BACKGROUND: Smoking impairs lung immune functions and damages upper airways, increasing risks of contracting and severity of infectious diseases METHODS: We searched PubMed and Embase for studies published from January 1-May 25, 2020 We included studies reporting smoking behavior of COVID-19 patients and progression of disease, including death We used a random effects meta-analysis and used meta-regression and lowess regressions to examine relationships in the data RESULTS: We identified 47 peer-reviewed papers with a total of 31,871 COVID-19 patients, 5,759 (18 1%) experienced disease progression and 5,734 (18 0%) with a history of smoking Among smokers, 29 2% experienced disease progression, compared with 21 1% of non-smokers The meta-analysis confirmed an association between smoking and COVID-19 progression (OR 1 56, 95% CI 1 32-1 83, p=0 001) Smoking was associated with increased risk of death from COVID-19 (OR 1 19, 95% CI 1 05-1 34, p=0 007) We found no significant difference (p=0 432) between the effects of smoking on COVID-19 disease progression between adjusted and unadjusted analyses, suggesting that smoking is an independent risk factor for COVID-19 disease progression We also found the risk of having COVID-19 progression among younger adults (p=0 023), with the effect most pronounced among people under about 45 years old CONCLUSIONS: Smoking is an independent risk for having severe progression of COVID-19, including mortality The effects seem to be higher among young people Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic
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