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Smoking, Vaping and COVID-19: What You Need to Know

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Posted by Jamie Garfield, MD

The number of coronavirus, or COVID-19, cases continues to increase worldwide. Here in the U.S., most people are following the same preventive measures, including social distancing (also known as physical distancing), frequent handwashing and staying at home. However, these are not the only steps you can take to decrease your risk.

If you smoke cigarettes or vape, you may be at a higher risk for a more severe illness if you’re infected with the virus causing COVID-19.

Here, I explain why and how you can move toward quitting smoking or vaping during these challenging times.

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Does smoking increase your risk of developing COVID-19?

Currently, there is conflicting data on the effect of smoking and vaping and the risk of developing COVID-19. Initial data from China pointed towards increased risk of COVID infection in smokers. However, more recent reports from France and New York highlight the unexpectedly low percentage of smokers among COVID-19 infections.

That said, both smoking cigarettes and vaping are closely linked to lung inflammation and lower immune function. When your immune system is weakened, you’re more susceptible to developing a serious illness.

We know typical symptoms of COVID-19 are cough, fever, fatigue and in severe cases, difficulty breathing. If your respiratory system is already vulnerable from smoking or vaping when you get COVID-19, it may make it difficult for you to handle the infection.

While most people who are infected with COVID-19 recover at home, a portion — about 15% — end up in the ICU with respiratory distress.

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How do smoking and vaping cause lung inflammation and lower immune function?

Inflammation is your body’s response to what it perceived as an attack. In the case of your lungs, inflammation is usually caused by exposure to toxins, pollutants or allergens. Cigarette smoke and e-cigarette emissions lead to lung inflammation because they damage the epithelial layer of the lungs. This is the outer layer that among other things helps protect the lungs from infection.

With continued exposure to chemicals from smoking and vaping, your lungs become damaged and scarred, leading to chronic lung diseases such as asthma and chronic obstructive pulmonary disease (COPD).

Both cigarette smoke and vaping emissions contain harmful chemical compounds that can interfere with the immune system. If your lungs and immune system are already compromised from cigarette use, an infection like COVID-19 might be very serious for you.

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If a person who smokes cigarettes or e-cigarettes develops COVID-19 infection, how sick will they get?

The Centers for Disease Control (CDC) reports that people with chronic lung disease, moderate to severe asthma, or who are immunocompromised from smoking may develop a more severe case of COVID-19, if they become infected. These people are what the CDC calls “our most vulnerable populations.”

In the most severe cases around the world, COVID-19 patients are admitted to the ICU with extreme shortness of breath and high fever. In some cases, they develop pneumonia, acute respiratory distress syndrome (ARDS) or sepsis, and a percentage of those patients die. If a person who smokes or vapes does get a COVID-19 infection, it may be difficult for them to overcome.

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If you quit smoking cigarettes or e-cigarettes, will you lower your chance of developing COVID-19?

We already know that within 2 to 9 weeks after you quit smoking, your lung function starts to improve. When your lungs are working properly, you’re better able to overcome threats such as infections. We also know long-term smokers tend to develop chronic cough.

The most common way we know COVID-19 is spread is mainly through close contact (about 6 feet or closer) from person-to-person in respiratory droplets from someone who is infected. That means if a smoker gets COVID-19, even if they do not have symptoms, they may spread the infection to others.

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Is vaping an effective way to quit smoking?

We know that there are many harmful substances in cigarettes. However, there is no evidence to recommend that smokers should take up vaping to help them quit smoking.

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Does social distancing make it more difficult to quit smoking or vaping?

Smoking cigarettes and vaping may be how you’re passing idle time during social distancing, but this may actually be a good time to quit — or at least move toward quitting.

Motivation and behavior play a huge role in smoking cessation. And now, while this serious virus continues to spread, you can use that threat as motivation to help you quit. Try the following:

1. Be aware of your triggers.

Therapists use mindfulness to help patients become more aware of their smoking triggers. Try to pay attention when you start to think about smoking or when you pull out your e-cigarette. What triggers that behavior? Did you just finish lunch, for example? Did you just hear a scary news flash on the TV?

Understanding your triggers is one of the first steps to overcoming your cravings.

2. Find other ways to relax.

Your feelings of stress and anxiety may be heightened during the COVID-19 pandemic. Instead of smoking, are there other behaviors you can incorporate into your day to help you overcome anxiety?

Here are 5 ways to manage stress and anxiety during social distancing >

3. Join a support group.

While social distancing, you may not be able to get out and join a support group in person, but there are a number of options online.

Freedom From Smoking®, for example, is an online program created by the American Lung Association. The program offers flexible sessions to help you quit smoking in as little as 3 weeks, even if you’ve tried before, then started again.

Support groups can provide you with education, motivation and an opportunity to learn from others just like you who want to quit or have successfully quit.

4. Medications to help you quit.

Talk to your doctor about FDA-approved medications like Nicotine replacement therapy, Varenicline (Chantix), and Bupropion (Wellbutrin). These products are not commonly used to help vapers quit, but this could be something you can discuss with your provider.

When to Call Your Doctor

If you smoke cigarettes or vape and experience cough, fever or difficulty breathing, call your doctor. Be sure to tell them about your smoking or vaping history.

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Jamie Garfield, MD

Dr. Garfield is a pulmonologist with the Temple Lung Center and has clinical interests in interventional pulmonology, lung cancer and pulmonary nodules, women's health and gender disparities in lung disease, and LGBTQ health. Dr. Garfield is also the Director of Quality and Improvement and Patient Safety, Core Clinical Faculty, Internal Medicine Residency, at Temple University Hospital. She is Associate Professor of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University, and its Core Clinical Educator.

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