A good time to quit: Smoking and vaping amid COVID-19

As COVID-19 infections continue to rise and cold and flu season take hold, physicians are adamantly advising patients to do all they can to remain healthy—including not smoking or vaping.

Multiple studies have shown that smoking is associated with increased severity of COVID-19 disease. However, because vaping, which is the use of nicotine-containing electronic or e-cigarette products, is relatively new, there is less data.

"But it is clear that smoking and vaping are bad for the lungs. Patients who smoke and vape can have damaged lungs that make them susceptible to respiratory infections, including COVID-19," says Charles Dela Cruz, MD, Ph.D., a Yale Medicine pulmonologist, critical care physician, and specialist in respiratory infections.

A possible link between vaping and COVID-19 risk

A survey of 13- to 24-year-olds found that a COVID-19 diagnosis was five times more likely among those who vaped and seven times more likely among those who vaped and smoked.

Stephen Baldassarri, MD, MHS, a Yale Medicine pulmonary, critical care, and addiction medicine specialist, points out that little is known about other factors among survey participants that could have increased their risk of COVID-19. "While there could be effects from smoking or vaping, we don't know why these individuals have been more frequently diagnosed with COVID-19," Dr. Baldassarri says. "It would be important to find out more about frequency of testing, mask usage, group gatherings, and social behaviors, among other possible factors."

For example, smoking and vaping are often social activities, with users sometimes sharing cigarettes and devices, being in close proximity to one another, and not wearing masks.

Regardless, Dr. Baldassarri emphasizes that now is a good time to promote healthy behaviors.

"We always want to encourage and help people to stop smoking or vaping whenever possible. This can be very difficult, and health care providers can provide treatment to help with this. It is important to engage in other healthy behaviors, prioritizing sufficient sleep, a varied and healthy diet, reduction of excess body weight, and daily exercise," he says. "Stress management techniques are also helpful. I like to meditate for at least 10 minutes daily to reduce mental stress and improve my ability to focus. Those are the practices we want to have to keep us healthy and minimize the effects of illnesses."

COVID-19 is an important reminder that we should try to be as healthy as possible, he adds.

Smoking heightens risk of respiratory viruses

Approximately 34 million American adults smoke. In 2019, about 53% of high school students and 24% of middle-school students reported having ever tried a tobacco product (cigarettes, e-cigarettes, and others).

Given these numbers, medical experts want adults and youth to recognize that smoking leads to disease and disability, harming every organ system in the body.

"Smoking can irritate the airways and change the immune cells, making them pro-inflammatory, which increases the level of inflammation in the large and small airways," Dr. Baldassarri says.

Increased inflammation in the lungs sets someone up for a tough time warding off a virus, doctors explain. Smoking also damages cilia, the hair-like structures that line the lungs, and move microbes and debris out of the way. This can make it easier for viruses to invade. Over the years, studies have consistently shown, for example, that smokers who get the flu are more likely to be hospitalized than nonsmokers.

With cold and flu season upon us, Dr. Dela Cruz says that now is the time to encourage social distancing, mask-wearing, cessation from smoking or vaping, and staying up to date on vaccines, including flu shots for all and pneumonia shots for older adults and those at risk.

"In general, smokers or vapers are more at risk for COVID-19 infection and more at risk for more severe outcomes when they get infected," Dr. Dela Cruz says.