SMOKERS COULD LOWER their risk of severe illness from Covid-19 by quitting their habit.

“Active smoking increases your risk of respiratory tract infection,” says Professor Tom Wilkinson, NHS consultant physician and researcher at the University of Southampton.

Those with lung disease and certain medical conditions are at greater risk of severe sickness from the novel-coronavirus.

A study of 1,590 patients with Covid-19 in China found that this is true for patients with cardiovascular disease, diabetes, hypertension and chronic obstructive pulmonary disorder (COPD).

COPD is a disease that makes it hard to empty air out of your lungs. The airways get smaller, leading to airflow obstruction, according to COPD Support Ireland.

This can result in shortness of breath or tiredness. It affects around half a million people in Ireland, though fewer than half are diagnosed.

“It is associated with patients who are older, 60s and 70s typically,” says Professor Tim McDonnell, consultant respiratory physician at St Vincent’s University Hospital, Dublin.

Patients can develop it over years and lots don’t realise.”

COPD patients in China were more likely to suffer more severe illness from the SARS-CoV-2 virus. Patients with COPD who smoke can help themselves by quitting, now.

“Whatever stage you stop smoking, your disease outcome is better, and that is certainly true in the context of infectious disease,” says Wilkinson.

His studies show that certain COPD patients, though not all, are more susceptible to both bacterial and viral infections. One reason is that the lung defends itself by using a mucus escalator, which helps clear contaminants. This is damaged in many patients with COPD.

“COPD is a common condition in China due to the frequency of smoking and exposure to environmental pollution,” says Wilkinson, though it often goes unrecognised.

In some of the best health systems in the world, only a minority of COPD patients receive a formal diagnosis.

The professor suspects that the true toll of having COPD in this pandemic is underestimated.

Around 12,000 patients with worsening COPD are admitted to hospital each year, says McDonnell.

He tells his COPD patients that they should regard everyone they meet as potentially having the Covid-19 virus.

“Avoid social contact,” he advises.

He notes also that the Italian death rates seem to be higher than in China.

“One of the factors has perhaps been smoking, perhaps pollution in the Lombardy region too,” says McDonnell.

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“About one in four Italians are over 65, so you are dealing with an elderly population, who probably have higher rates of smoking.”

Professor Wilkinson’s research focuses on understanding the mechanisms which contribute to the vulnerability to and the impact of respiratory infections in patients with chronic lung disease.

“If you have a diagnosis of COPD and you are concerned about infection, then stopping smoking is a relevant lifestyle change, in the context of Covid-19 and more generally,” he advises.

Dr McDonnell agrees: “There is some evidence that patients who get Covid-19 and who are smokers do worse.”

The advice for vaping is evolving, Wilkinson adds, but his view: “If you have a choice between vaping and not vaping, it is better not to vape, because if you are inhaling anything which can irritate the lung, in the context of COPD and infection, that is only going to lead to a worse outcome.”

Ideally, patients would be better to try nicotine-replacement therapy.

Anthony King is a freelance science journalist in Dublin.