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Coronavirus (COVID-19)

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

JAMA Internal Medicine

Published Online: January 25, 2021

Research Letter

Article Information and Disclosures

Katherine E. Lowe, MSc¹;

Joe Zein, MD, PhD²;

Umur Hatipoğlu, MD²;

Amy Attaway, MD²

Author Affiliations

¹Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
²Respiratory Institute, Cleveland Clinic, Cleveland, Ohio

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There is limited and contradictory evidence on the association of smoking status with adverse outcomes of severe acute respiratory syndrome coronavirus 2 infection.¹^- 3 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

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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/ntaa059 PubMed Google Scholar Crossref

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/NEJMoa2002032 PubMed Google Scholar Crossref

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.2020.06.007 PubMed Google Scholar Crossref

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.2020.1855 PubMed Google Scholar Crossref

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/NEJMsa2011686 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.