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Association of Smoking and Cumulative Pack-Year Exposure With COVID-19 Outcomes in the Cleveland Clinic COVID-19 Registry

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

There is limited and contradictory evidence on the association of smoking status with adverse outcomes of severe acute respiratory syndrome coronavirus 2 infection.13 Furthermore, current smoking status does not encompass the cumulative effect of smoking. To our knowledge, no studies have assessed the cumulative effect of smoking over time, as measured by pack-years, though a single study of coronavirus disease 2019 (COVID-19) in a small cohort of 102 patients with lung cancer found that the patients with severe outcomes had a higher average pack-year history (30 vs 20 years).4 We hypothesize that there is an adverse association of cumulative smoking exposure, as measured by pack-years, with outcomes of patients with COVID-19.

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Article Information

Accepted for Publication: November 7, 2020.

Published Online: January 25, 2021. doi:10.1001/jamainternmed.2020.8360

Correction: This article was corrected on March 8, 2021, to fix a data error in the Results section.

Corresponding Author: Katherine E. Lowe, MSc, Cleveland Clinic Lerner College of Medicine of Case Western Reserve, 9501 Euclid Ave, Cleveland, OH 44195 (lowek@ccf.org).

Author Contributions: Ms Lowe had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Lowe, Hatipoğlu, Attaway.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Lowe, Zein, Attaway.

Administrative, technical, or material support: Hatipoğlu

Supervision: Zein, Hatipoğlu, Attaway.

Conflict of Interest Disclosures: Dr Hatipoğlu reports receiving royalties from Wolters Kluwer Health for his work as section editor for UpToDate. No other disclosures were reported.

Funding/Support: Research support was provided through a grant from the National Institutes of Health’s National Heart, Lung, and Blood Institute (K08HL133381).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Patanavanich  R , Glantz  SA .  Smoking is associated with COVID-19 progression: a meta-analysis.   Nicotine Tob Res. 2020;22(9):1653-1656. doi:10.1093/ntr/ntaa082PubMedGoogle ScholarCrossref
2.
Berlin  I , Thomas  D , Le Faou  AL , Cornuz  J .  COVID-19 and smoking.   Nicotine Tob Res. 2020;22(9):1650-1652. doi:10.1093/ntr/ntaa059PubMedGoogle ScholarCrossref
3.
Guan  WJ , Ni  ZY , Hu  Y ,  et al; China Medical Treatment Expert Group for Covid-19.  Clinical characteristics of coronavirus disease 2019 in China.   N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032PubMedGoogle ScholarCrossref
4.
Luo  J , Rizvi  H , Preeshagul  IR ,  et al.  COVID-19 in patients with lung cancer.   Ann Oncol. 2020;31(10):1386-1396. doi:10.1016/j.annonc.2020.06.007PubMedGoogle ScholarCrossref
5.
Mehta  N , Kalra  A , Nowacki  AS ,  et al.  Association of use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with testing positive for coronavirus disease 2019 (COVID-19).   JAMA Cardiol. 2020;5(9):1020-1026. doi:10.1001/jamacardio.2020.1855PubMedGoogle ScholarCrossref
6.
Price-Haywood  EG , Burton  J , Fort  D , Seoane  L .  Hospitalization and mortality among black patients and white patients with Covid-19.   N Engl J Med. 2020;382(26):2534-2543. doi:10.1056/NEJMsa2011686PubMedGoogle ScholarCrossref
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