Role of tobacco in pandemic COVID-19 in India

Ankit Gupta, Bheem Dutt, Mahendra Singh


Since the end of 2019, the world has witnessed the spread of a COVID-19, that affects the respiratory system of the body in the form of the novel coronavirus. This pandemic has affected people across all socioeconomic demographics and cultures in high-, middle- and low- income countries. Tobacco is also a major risk factor for many diseases like cardiovascular disease, cancer, respiratory disease and diabetes which put people with these conditions at higher risk for developing severe illness when affected by COVID-19. Minimizing the use of tobacco and smoking might be an important factor for containing COVID-19 infection. On the other side, studies also suggest also that smoking is associated with a decreased risk of hospital admission with a diagnosis of COVID-19, or a decreased risk of occurrence of the disease in the community. These studies have noted 4 to 5 times lower proportions of smokers among patients hospitalized for COVID-19 compared with the underlying source population. A metanalysis of hospital case series confirmed this gap.


COVID-19, Pandemic, Tobacco, Smoking

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Strzelak A, Ratajczak A, Adamiec A, Feleszko W. Tobacco smoke induces and alters immune responses in the lung triggering inflammation, allergy, asthma and other lung diseases: a mechanistic review. Int J Environ Res Public Health. 2018;15(5):1033.

Khot WY, Nadkar MY. The 2019 Novel Coronavirus Outbreak–A Global Threat. J Assoc Physicians India. 2020;68(3):67.

Tonnesen P, Marott JL, Nordestgaard B, Bojesen SE, Lange P. Secular trends in smoking in relation to prevalent and incident smoking-related disease: A prospective population-based study. Tob Induc Dis. 2019;17.

Hogg JC, Timens W. The Pathology of Chronic Obstructive Pulmonary Disease. Annual Rev Pathol-Mechanisms of Dis. 2009;4:435-59.

Forsslund H, Mikko M, Karimi R, Grunewald J, Wheelock AM, Wahlstrom J, et al. Distribution of T-cell subsets in BAL fluid of patients with mild to moderate COPD depends on current smoking status and not airway obstruction. Chest. 2014;145:711-22.

Zhang MQ, Wan Y, Jin Y, Xin JB, Zhang JC, Xiong XZ, et al. Cigarette smoking promotes inflammation in patients with COPD by affecting the polarization and survival of Th/Tregs through up-regulation of muscarinic receptor 3 and 5 expression. PLoS One. 2014;9:e112350.

Vardavas CI, Plada M, Tzatzarakis M, Marcos A, Warnberg J, Gomez-Martinez S, et al. Passive smoking alters circulating naive/memory lymphocyte T-cell subpopulations in children. Pediatr Allergy Immunol. 2010;21:1171-8.

Vargas-Rojas MI, Ramirez-Venegas A, Limon-Camacho L, Ochoa L, Hernandez-Zenteno R, et al. Increase of Th17 cells in peripheral blood of patients with chronic obstructive pulmonary disease. Respir Med. 2011;105:1648-54.

Wang H, Peng W, Weng Y, Ying H, Li H, Xia D, et al. Imbalance of Th17/Treg cells in mice with chronic cigarette smoke exposure. Int Immunopharmacol. 2012;14:504-12.

Harrison OJ, Foley J, Bolognese BJ, Long E, Podolin PL, Walsh PT. Airway infiltration of CD4+ CCR6+ Th17 type cells associated with chronic cigarette smoke induced airspace enlargement. Immunol Lett. 2008;121:13-21.

Shan M, Yuan X, Song LZ, Roberts L, Zarinkamar N, Seryshev A, et al. Cigarette smoke induction of osteopontin (SPP1) mediates T(H)17 inflammation in human and experimental emphysema. Sci Transl Med. 2012;4:117-9.

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, The health consequences of smoking: 50 years of progress - A report by the Surgeon General, Atlanta. 2014.

Murin S, Bilello K. Respiratory tract infections: Another reason not to smoke. Cleveland Clinic J Med. 2005;72:10.

Lönnroth K, Raviglione M. Global Epidemiology of Tuberculosis: Prospects for Control. Semin Respirat Crit Care Med. 2008;29(5):481-91.

World Health Organization, Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim Guidance. 2020. Available at: handle/10665/331446. Accessed on 24 January 2022.

Hsieh S, Zhuo H, Benowitz N, Thompson B, Liu K, Matthay M, et al. Prevalence and impact of active and passive cigarette smoking in acute respiratory distress syndrome. Crit Care Med. 2014;42(9):2058-68.

Calfee C, Matthay M, Kangelaris K, Siew E, Janz D, Bernard G, et al. Cigarette Smoke Exposure and the Acute Respiratory Distress Syndrome. Crit Care Med. 2015;43(9):1790-7.

John RM, Sung HY, Max W. Economic cost of tobacco use in India, 2004. Tobacco Control. 2009;18:138-43.

Gupta PC, Mehta HC. Cohort study of all-cause mortality among tobacco users in Mumbai, India. Bull. World Health Organ. 2000;78:877-83.

Gupta PC, Pednekar MS, Parkin DM, Sankaranarayanan R. Tobacco-associated mortality in Mumbai (Bombay) India. Results of the Bombay Cohort Study. Int J Epidemiol. 2005;34(6):1395-402.

Gupta C, Bhonsle RB, Mehta FS, Pindborg JJ. Mortality experience in relation to tobacco chewing and smoking habits from a 10-year follow-up study in Ernakulam District, Kerala. Int J Epidemiol. 1984;13:184-7.

Gupta PC, Mehta FS, Pindborg JJ. Mortality among reverse chutta smokers in south India. BMJ. 1984;289:865-6.

International Agency for Research on Cancer (IARC) Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans, Vol. 37. Available at: Accessed on 24 January 2022.

Kulkarni S. Sero-survey across districts to study extent of COVID-19 spread. Available at: Accessed on 24 January 2022.

90% of smokeless tobacco users live in South-East Asia. Available at: eastasia/news/detail/11-09-2013-90-of-smokeless-tobacco-users-live-in-south-east-asia. Accessed on 24 January 2022.

van Zyl-Smit RN, Richards G, Leone FT. Tobacco smoking and COVID-19 infection. The Lancet Respiratory Medicine. 2020;8(7):664-5.

Alla F, Berlin I, Nguyen-Thanh V, Guignard R, Pasquereau A, Quelet S, et al. Tobacco and COVID-19: a crisis within a crisis? Canad J Public Health. 2020;111(6):995-9.