Introduction
COVID19 is a respiratory disease that affects the breathing system organs leading to difficulties in inhalation. Since it is a respirational infection, it manifests significantly in the lungs, especially in patients with a smoking history. Studies have been done concerning these patients to determine how well care can be given to them to ensure they recover faster and adequately. Nurses play a significant role in spreading awareness regarding maintaining good health throughout the pandemic and treatment and care for COVID19 patients with different conditions. A research question was formulated, and articles were peer-reviewed to address this issue.
PICOT Question
For COVID19 patients, how does being a smoker compared to a non-smoker influence the severity of the disease and hospitalization?
Hypothesis
Smokers who contract the COVID19 suffer more severe symptoms than non-smokers and are at a greater risk of hospitalization and mortality.
Objectives
- To study the effect of COVID19 on current tobacco smokers and patients with a history of smoking.
- To study the prognosis in terms of severity of SARS-COV2 on tobacco smokers in comparison with non-smokers.
- To compare the rate of mortality due to COVID19 for people with a history of smoking and non-smokers.
- To help nurses understand the need to help patients with a history of tobacco smoking and who are COVID19 positive quit using.
Literature Review
In 2020, the World Health Organization (WHO) broadcasted information about the effect of COVID-19 on smokers. They stated that smokers were at a higher risk of having aggravated disease symptoms if they were infected (“WHO statement: Tobacco use and COVID-19”, 2021). It was further explained that the virus would quickly infest the rest of the system due to their already compromised lungs and respiratory system. Especially since it is a respiratory disease that affects similar places as tobacco, this information coincides with other respiratory diseases such as influenza regarding cigarette smoking.
On the contrary, the rate of infection and hospitalization for current smokers was lower than that of former smokers. Former smokers were more predisposed to the disease and its severe effects. It has been explained that cigarette smoke stimulates alterations in the bronchial epithelium, which causes goblet cells metaplasia (Polverino, 2020). Since these cells produce mucous, the excessive mucous produced acts as a barrier for inhaled pathogens such as viruses, reducing pathogenic invasion. On the other hand, former smokers have more bare respiratory systems prone to any related infections.
Conferring to the Center for Disease Control (CDC), smoking increases the risk of contracting and suffering severe COVID-19 disease. Cigarette smoking depresses immunity and may cause lung inflammation which disposes of the smoker of pulmonary infections. It can also destroy epithelial cells of the respiratory tract containing cilia that actively defend the body against infection by COVID19. Tobacco also induces the production of ACE2 receptors, which are used by the SARS-COV2 pathogen to get into the cells in the lungs hence causing severe disease and symptoms. Due to these predispositions, human beings should take precautions by avoiding or quitting smoking for the good of their health.
Methodology
The research was done by combining current literary issues concerning COVID-19 and cigarette smoking, focusing on Tobacco. Most peer-reviewed papers studied four groups of people; current smokers, non-smokers, former smokers, and passive smokers. These groups of patients were monitored for some time through which some suffered mild symptoms, others severe symptoms and others died. All these outcomes were based on the condition of their respiratory tract with particular reference to their smoking record.
A study done by Guan et al. 2020 in China using a population of 1099 patients contributed to the findings of this research. Of these people, 173 showed severe symptoms; 16.9% were current smokers, and 5.2% were former smokers (Guan et al., 2020). Of the number of patients who had to be placed in ICU or needed ventilation to aid in their breathing or died, 25.5% were current smokers, and 7.6% were former smokers (Guan et al., 2020). On the contrary, only 11.8% were current smokers and 1.6% were former patients who did not suffer these austere symptoms.
In another study by Zhang et al. 2020, patients who suffered adverse symptoms were monitored. 25% of them had a history of smoking and showed minor signs of recovery, and only 3% of these patients exhibited stabilization (Zhang et al., 2020). However, the disease was manifested significantly in both groups since their respiratory tracts were already damaged by tobacco. The mortality rate was also recorded in some studies showing that a higher percentage died in a population of people with a smoking history.
Results
It was found that people with a history of smoking were:
- At a higher risk of contracting the COVID19 disease due to their already endangered immunity caused by tobacco that generally damages the lungs and the respiratory tract.
- Prone to suffering severe symptoms and prognosis of the disease with quite adverse outcomes since their bodies’ capability to deal with the virus is low and inefficient.
- Most likely to be hospitalized and admitted to the ICU for ventilation to aid in their breathing since the damage done to their lungs is quite severe and predisposes them to congestion.
- At high risk of mortality in cases where their respiratory tracts had already been harshly affected by tobacco before infection, chances of survival were minimal.
Discussion and Relevance
Cigarette smoking was proved to pose a significant risk to people who partook in it. Patients with a history were seen to suffer severe symptoms and outcomes of the virus. Cases of mortality were also inclined to smokers rather than a non-smoker. COVID19 was proved to be a vital respiratory tract disease whose progression was increased by smoking, either current or former (“WHO statement: Tobacco use and COVID-19”, 2021). Tobacco was seen to increase the viability of the virus in ways such as the induction of the ACE2 receptors of the lungs. Therefore, hospitalization rates for partakers were on the higher side since the patients needed aid in breathing and, consequently, surviving.
The hypothesis is valid since all assumptions made were proved correct. According to the above studies, a high percentage of smokers who contracted COVID19 were generally admitted to the ICU for critical care since their symptoms were severe. Moreover, the mortality rate for these patients was relatively high compared to non-smokers (Zhou et al., 2020). Nurses who serve as caregivers for such people and patients in general are, therefore, obligated to spread awareness to their patients to reduce these occurrences (for both COVID19 patients and other respiratory diseases)
The above findings are expected to help nursing practitioners understand the need to sensitize the public on the effects of smoking during the COVID19 pandemic. This information can explain to affected patients to recognize the need to quit or avoid smoking to maintain healthy lives and subsequently survive the epidemic. Lastly, the above research aims to reduce hospitalization and mortality rates worldwide, even by a minuscule percentage.
Conclusion
Since time immemorial, tobacco smoking has led to respiratory diseases such as lung cancer and influenza. COVID19 is an excellent example of these infections and is a current threat to life today. The human population must avoid smoking as much as possible. Current smokers are advised to quit, and non-smokers stay away from the drug for higher chances of survival during this pandemic. This way risk of contracting and causes of mortality will be lower.
References
Guan, W. J., Ni, Z. Y., Hu, Y., Liang, W. H., Ou, C. Q., He, J. X., & Zhong, N. S. (2020). Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine, 382(18), 1708-1720.
Polverino F. (2020). Cigarette Smoking and COVID-19: A Complex Interaction. American journal of respiratory and critical care medicine, 202(3), 471–472. Web.
WHO statement: Tobacco use and COVID-19. Who. int. (2021). Web.
Zhang, J. J., Dong, X., Cao, Y. Y., Yuan, Y. D., Yang, Y. B., Yan, Y. Q & Gao, Y. D. (2020). Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy, 75(7), 1730-1741.
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z. & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. The Lancet, 395(10229), 1054-1062.