Smoking increases expression of the SARS-CoV-2 spike protein-binding long ACE2 isoform in bronchial epithelium

Pouwels, Simon D.; Berge, Maarten van den; Vasse, Gwenda F.; Timens, Wim; Brandsma, Corry‐Anke; Aliee, Hananeh; Hiemstra, Pieter S.; Guryev, Victor; Faiz, Alen

doi:10.1186/s12931-023-02430-5

Cited by 2 publications

(1 citation statement)

References 10 publications

(13 reference statements)

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“…Cigarette smoke (CS) is a major risk factor for developing COPD and has recently been identified as a predisposing factor for SARS-CoV-2 infection [24,35,48,49]. Recent evidence indicates that exposure to CS upregulates pulmonary ACE2 levels, the predominant host viral entry receptor for SARS-CoV-2 [50,51].…”

Section: Cigarette Smoke Vaping and Covid-19mentioning

confidence: 99%

The Complex Association between COPD and COVID-19

Awatade

Wark

Chan

et al. 2023

JCM

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Chronic obstructive pulmonary disease (COPD) is significant cause of morbidity and mortality worldwide. There is mounting evidence suggesting that COPD patients are at increased risk of severe COVID-19 outcomes; however, it remains unclear whether they are more susceptible to acquiring SARS-CoV-2 infection. In this comprehensive review, we aim to provide an up-to-date perspective of the intricate relationship between COPD and COVID-19. We conducted a thorough review of the literature to examine the evidence regarding the susceptibility of COPD patients to COVID-19 infection and the severity of their disease outcomes. While most studies have found that pre-existing COPD is associated with worse COVID-19 outcomes, some have yielded conflicting results. We also discuss confounding factors such as cigarette smoking, inhaled corticosteroids, and socioeconomic and genetic factors that may influence this association. Furthermore, we review acute COVID-19 management, treatment, rehabilitation, and recovery in COPD patients and how public health measures impact their care. In conclusion, while the association between COPD and COVID-19 is complex and requires further investigation, this review highlights the need for careful management of COPD patients during the pandemic to minimize the risk of severe COVID-19 outcomes.

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Section: Cigarette Smoke Vaping and Covid-19mentioning

confidence: 99%

The Complex Association between COPD and COVID-19

Awatade

Wark

Chan

et al. 2023

JCM

View full text Add to dashboard Cite

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New insights into the paradox between smoking and the risk of SARS-CoV-2 infection (COVID-19): Insufficient evidence for a causal association

Kramer,

Zhu,

Van Westen-Lagerweij

et al. 2024

Scand J Public Health

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Aims: Previous studies have reported a ‘smoker’s paradox’, where people who smoke appear to be protected against Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) infection (COVID-19). This conflicts with well-established evidence that people who smoke are generally more vulnerable to respiratory infections. In this study, we aimed to validate the association between smoking and SARS-CoV-2 infection in a general Dutch population, and to evaluate the evidence underlying the possible causal relationship between smoking and SARS-CoV-2 infection by applying a modern adaptation of the Bradford Hill criteria. Methods: In total, 57,833 participants from the Lifelines Cohort Study were included in the analysis. Smoking status, including never smoker, current smoker, and former smoker, was derived from the Lifelines general assessment between 2014 and 2017, while SARS-CoV-2 infection status was derived from an additional COVID-19 questionnaire from 2021 to 2022. Logistic regressions were used for the association between smoking status and infection status. The adapted Bradford Hill’s criteria, including the strength of association (including an analysis of plausible confounding), plausibility, temporality and study design suitability, were applied to evaluate the existing literature. Results: We found, compared with never smokers, an increased risk of SARS-CoV-2 infection for former smokers (odds ratio (OR)=1.07, 95% confidence interval (CI)=1.01–1.13), but a reduced risk for current smokers (OR=0.85, 95% CI=0.79–0.92), after adjusting for several relevant covariates. However, we discerned a possible explanation of the smoker’s paradox since we observed that current smokers were more likely to be non-responders to the COVID-19 questions and, more importantly, these non-responders were more likely to have other established risk factors for SARS-CoV-2 infection. Conclusions: There is insufficient evidence to suggest that smoking protects against SARS-CoV-2 infection. According to the adapted Bradford Hill’s criteria, we observed a high inconsistency between study results, a high possibility for residual confounding and no clear evidence for biological plausibility. Future studies should include linkage with the confirmed testing results from national healthcare registries to mitigate avoidable bias.

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Smoking increases expression of the SARS-CoV-2 spike protein-binding long ACE2 isoform in bronchial epithelium

Cited by 2 publications

References 10 publications

The Complex Association between COPD and COVID-19

The Complex Association between COPD and COVID-19

New insights into the paradox between smoking and the risk of SARS-CoV-2 infection (COVID-19): Insufficient evidence for a causal association

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