At the beginning of the pandemic, it was said that nicotine could protect against COVID-19. However, after months of studies of the disease caused by SARS-CoV-2, it is known that the relationship between smoking, COPD and COVID-19 is a cocktail that leads, in many cases, to severe COVID-19. Even with the need to be in the ICU with mechanical ventilation and, sometimes, it also ends in death.
This Wednesday was the World Day of Chronic Obstructive Pulmonary Disease, better known as COPD, Dr. Carlos A. Jiménez Ruiz, president of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) has spoken about the relationship between smoking, COPD and COVID-19. In fact, the specialist has pointed out on several occasions that “smoking and COPD worsen the prognosis of COVID-19.”
Underdiagnosis of COPD
“In 2016 56,124 people died due to tobacco and 84% of them were men,” explained Dr. Jiménez
“In 2016 56,124 people died due to tobacco and 84% of them were men”, has indicated Dr. Jiménez. “This means that tobacco killed more than 1,000 people a week”. The relationship between smoking and COPD is more than established. Most smokers end up developing this respiratory disease: “More than 85% of COPD cases are caused by tobacco. COPD is directly attributable to tobacco use,” explained Dr. Jiménez.
In addition, the specialist has pointed out that there is an “underdiagnosis” of COPD in our country since 74.7% of COPD cases “are undiagnosed”. This means that 3 out of 4 people with COPD they do not know. In fact, Jiménez has called for all smokers who are 35 years of age or older and who suffer from any respiratory symptoms to go to their doctor or pulmonologist “and request that they perform a spirometry.”
From the Association of Patients with COPD (APEPOC) they have also been very concerned about this underdiagnosis which is close to 75%. “This is because patients do not tell their doctors about the warning symptoms first, since they don’t want to admit that they smoke nor that they tell them to stop, “said Nicole Hass, spokeswoman for APEPOC.
In a systematic review and meta-analysis, Dr. Jiménez and his team have asked themselves two questions. The first, if the Smoking is a risk factor for progression to severe COVID-19 and if it is a risk factor for ICU, the need for mechanical ventilation and death. In both cases, the answer is yes. In 1.96 of the cases analyzed, smokers evolve to severe COVID-19 and in 1.79 of the cases, smokers enter the ICU, require mechanical ventilation and end up dying.
Furthermore, when asked if it is easier for a smoker to become infected with COVID-19, Jiménez has answered yes. This is due to several factors. The first is that smokers have more ACE2 receptors, which are what SARS-CoV-2 uses to infect. Furthermore, “smokers have a decrease in their lung defenses at the lung level,” Jiménez pointed out. So this can be a key factor in the development of the disease. And, above all, because “they touch their faces about 300 times more than people who do not smoke” due to the hand-mouth movement they use to smoke.
Ultimately, “the data indicates that COPD and smoking increase the predisposition to be infected by COVID-19,” the SEPAR specialist commented. “MERS, another simulated coronavirus, affected many people in the Middle East. It was shown that in the group of smokers they were infected more than those who were notIn fact, now with SARS-CoV-2 studies related to this are also beginning to come out. One done in Japan, cited by Jiménez, indicates that “there are more infections in areas where more smokers live.”
Therefore, smoking, and thus COPD patients, are more vulnerable to severe COVID-19. The biggest problem is that 3 out of 4 COPD patients don’t know they have it, so they do not know that they have to be more careful with COVID-19.
Yes, COPD patients should wear masks
Experts are clear about the use of masks in people with COPD: they must wear it. Not only because it is easier for them to get infected, according to preliminary data, but because COVID-19 tends to be more complicated in people with this previous pathology. So it is very important that they take better care of themselves and wear the mask. And that, while they can, avoid smoking around other people, especially on the street. Since we know that SARS-CoV-2 is spread through aerosols and tobacco smoke it is a good place from which to travel to other people.
In the event that a patient with COPD feels that he cannot breathe “it is better to use FPP2 or KN95 than a surgical one”
“The feeling of suffocation with the masks is more psychological than anything else”Hass pointed out. However, he added that in case you feel like you can’t breathe “it is better to use the FPP2 or KN95 than a surgical one.” “We should try to get COPD patients to wear masks because it is easier for them to have a more serious COVID-19.”
“There is a great fear of contagion of COVID-19 among smokers and ex-smokers,” said María Marín, who has not been smoking for 18 years. “I still have days that I think about taking it again, especially due to the brutal isolation that we are experiencing with the pandemic.” This woman is clear that this is the time for smokers to quit: “At a psychological and pharmacological level, there are options. They lack the willingness to say I’m going to quit” and COVID-19 should be the perfect excuse.
Dr. Jiménez, Nicole Hass and María Marín have met on World COPD Day in one of the Gebro Health Talks conferences, organized by Gebro Pharma Laboratories.
The article For this reason COVID-19 is usually more serious in patients with lung problems was published in Hypertext.