[COVID-19 and Smoking - A Position Paper by the DGP Taskforce for Smoking Cessation].

Tobacco smoking is associated with severe health risks. In 2020, the WHO estimated that 8 million people have died due to smoking. Furthermore, smoking tobacco is a well-known risk factor for various infectious pulmonary diseases. The question raised, whether smoking is facilitating SARS-CoV-2-infections and increases adverse outcomes of COVID-19. To answer these questions a narrative review was conducted, finally including 7 systematic reviews with meta-analyses published in January and February 2021. Tobacco smoking was associated with an increased COVID-19 disease severity (odds ratio range of active vs. never smokers 1.55-2.19 and former vs. never smokers 1.20-2.48) and an increased COVID-19 in-hospital mortality (odds ratio range of active vs. never smokers 1.35-1.51 and former vs. never smokers 1.26-2.58). Beside immediate pulmonary toxic effects through active smoking, the cumulative livelong tobacco exposition and subsequent tobacco-associated diseases seem to predominantly predict adverse outcomes in patients with COVID-19. Data regarding an increased risk of infection among smokers is conflicting. However, a large observational study from England with 2.4 million persons reported an association between tobacco smoking and typical symptoms of COVID-19. For e-cigarettes and vaping less data exist, but experimental and first clinical investigations also suggest an increased risk for adverse outcomes for their use and SARS-CoV-2 infections. Especially during the current SARS-CoV-2 pandemic with limited therapeutic options it is particularly important to advise smokers of their increased risks for unfavourable COVID-19 outcomes. Evidence based support for smoking cessation should be offered. In Germany, the existing and well-established methods to support tobacco cessation need to be reimbursed by statutory health insurances.
Competing Interests: R. Bals erhielt Forschungsunterstützung durch das BMBF, Wilhelm Sander Stiftung, Deutsche Krebshilfe, Mukoviszidose e. V., Schwiete Stiftung sowie Zuwendungen für Advisory Boards oder Vorträge von AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, CSL Behring.W. Pankow hatte Einkünfte aus Beratungstätigkeit für Pfizer Deutschland GmbH.C. Rustler: Geschäftsführung im Deutschen Netz Rauchfreier Krankenhäuser & Gesundheitseinrichtungen, Zuwendungen zur Implementierung des „rauchfrei tickets“ zur Vermittlung in die Rauchstoppberatung am Telefon der BZgA, Mitgliedschaft im Wissenschaftlichen Aktionskreis Tabakentwöhnung WAT e. V., Mitautorin der S3-Leitlinie „Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung“ (2021).Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.
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