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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 26  |  Issue : 1  |  Page : 85-87

Smoking cessation in COVID-19: A silver lining to the cloud


Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung hospital, New Delhi, India

Date of Submission26-Nov-2020
Date of Decision26-Jan-2021
Date of Acceptance01-Mar-2021
Date of Web Publication30-Jul-2021

Correspondence Address:
Rohit Kumar
Department of Pulmonary, Critical Care and Sleep Medicine, Vmmc And Safdarjung Hospital, New Delhi-110029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmhhb.jmhhb_204_20

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How to cite this article:
Yadav SR, Kumar R, Ish P, Gupta N. Smoking cessation in COVID-19: A silver lining to the cloud. J Mental Health Hum Behav 2021;26:85-7

How to cite this URL:
Yadav SR, Kumar R, Ish P, Gupta N. Smoking cessation in COVID-19: A silver lining to the cloud. J Mental Health Hum Behav [serial online] 2021 [cited 2021 Dec 1];26:85-7. Available from: https://www.jmhhb.org/text.asp?2021/26/1/85/322821



Sir,

The ill-effects of tobacco have been noticed from the 17th century, however, most cessation programs even till date have poor success.[1] Smoking tobacco is known to cause various respiratory and cardiovascular diseases, i.e., lung cancer, chronic obstructive pulmonary disease (COPD), increased risk of tuberculosis (TB), coronary artery disease, and hypertension.[2] Smoking is a scourge on humanity, it affects the smoker as well as people around him through secondhand smoke.

Smoking ill-effects have multiplied in the COVID-19 pandemic-people with cardiovascular disease and myocardial infarction have increased fatal outcomes,[3] besides, a meta-analysis done by Zhao et al. inferred that COPD and ongoing smoking history attribute to the worse progression and outcome of COVID-19.[4] Another recent study has postulated that the odds of progression toward serious illness were 14 times higher among people with a history of smoking.[5] Such findings are a matter of concern as one in five adults around the world is smoker. The practice of cluster smoking, especially in India, where hukkah is shared among individuals with a common pipe can promote spread of COVID-19. Hand and mouth movement during puffing of tobacco products leads to physical contact of hand to mouth making a smoker more vulnerable to COVID-19 infection. Similarly, vaping and E-cigarettes use is a high-risk behavior in context to COVID-19. The prevalence of smoking is on a declining trend in developed nations, from 10.70 in the 1960s to 3.2 cigarettes per person per day in the current times.[6] However, developing counties with nutritionally deficient populations, high prevalence of TB, and higher smoking prevalence are more prone to widespread health impacts by COVID-19.[7]

The increased occurrence of TB and respiratory infections with smoking has been shown to be linked to altered immune response including multiple defects in immune cells such as macrophages, monocytes and CD4 lymphocytes, mechanical disruption of ciliary function, and hormonal effects.[8] Similar mechanisms could be attributing to poor outcomes and higher progression rates to severe illness in smokers with COVID-19 infection.

Smoking cessation has been a priority of all health organizations world over. This COVID pandemic in which most of the world was under lockdown, is probably the ideal time to quit. Due to fear and panic of COVID-19 infection, health is being increasingly recognized as a priority target by the public. This motivation can be the first step to quit smoking. Many smokers who are at home due to lockdown are not smoking due to social obligations, respect and fear of elders, loss of stimulating cues such as parties, social drinking, and office lunchtimes/tea breaks. The availability of cigarettes is limited, both in fixed times and locations. In the initial phases of lockdown in India, it was available only in the gray market being a nonessential item.

In a recent report from Global Adult Tobacco Survey, 55.4% of current smokers have been thinking to quit smoke in coming future.[9] This group of population should be the priority audience for health care providers involved in smoking cessation programs during this COVID-19 pandemic and its induced lockdown. This willing population must be outreached and offered help. The interventions offered by tobacco cessation clinics and health facilities are, nonpharmacological, and pharmacological [Table 1]. The patient should be assessed for current smoking status, readiness to quit, barriers, and psychological issues. The goal of the treatment should be determined, which may differ for each patient, i.e., harm reduction, short-term quitting, initiation of quit attempt, or the ultimate goal of long-term abstinence. Telemedicine can help in follow-up, aiding in motivation and as a checkpoint for long-term abstinence. It has already been suggested for use by psychiatrists and recent guidelines have also been released for the same.[10],[11]
Table 1: Nonpharmacological and pharmacological interventions for smoking cessation

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The national authorities can aid by enacting and enforcing national tobacco laws. The World Health Organization has prioritized steps for the government to achieve cessation; the six components of which [summarized in [Table 2]] should be enforced strictly.[12] Few additional effective actions that can be incorporated by government and health providers in this COVID-19 pandemic era include – (a) Smokers should be cautioned, that they are venerable to catch COVID-19 infection; (b) Tobacco shops can be closed on a rotational basis, as they are nonessential item; (c) Costumers reaching such shops should be counseled and motivated to quit smoking and enrolled in cessation programs online. (posters, electronic chatbots equipped with artificial intelligence can help in motivation); (d) Group sessions of cessation programs can be telecasted through online platforms used for group meetings, social media sites, and enrollment should be free of cost; and (e) holistic approach needs to be offered (counseling, pharmacological treatment, motivation, and yogic exercises) through online or tele-medication approach.
Table 2: MPOWER as advocated by World Health Organization for promoting smoking cessation

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In COVID-19 pandemic times, when health is at the highest stake for every individual, smoking cessation is achievable if actively pursued.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumar R, Prasad R. Smoking cessation: An update. Indian J Chest Dis Allied Sci 2014;56:161-9.  Back to cited text no. 1
    
2.
Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med 2004;164:2206-16.  Back to cited text no. 2
    
3.
Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:811-8.  Back to cited text no. 3
    
4.
Zhao Q, Meng M, Kumar R, Wu Y, Huang J, Lian N, et al. The impact of COPD and smoking history on the severity of COVID-19: A systemic review and meta-analysis. J Med Virol 2020;92:1915-21.  Back to cited text no. 4
    
5.
Liu W, Tao ZW, Wang L, Yuan ML, Liu K, Zhou L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl) 2020;133:1032-8.  Back to cited text no. 5
    
6.
Ritchie H, Roser M. Smoking. Available from: https://ourworldindata.org/smoking. [Last accessed on 2020 Nov 07].  Back to cited text no. 6
    
7.
Yadav SR, Kumar R, Gupta N, Ish P, Chakrabarti S, Kumar A, et al. COVID-19: Avoiding a second tragedy in a tuberculosis burdened country. Monaldi Arch Chest Dis 2020;90:311-2. [doi: 10.4081/monaldi.2020.1338].  Back to cited text no. 7
    
8.
Alavi-Naini R, Sharifi-Mood B, Metanat M. Association between tuberculosis and smoking. Int J High Risk Behav Addict 2012;1:71-4.  Back to cited text no. 8
    
9.
Global Adult Tobacco Survey FACT SHEET|INDIA 2016-17. Available from: https://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_FactSheet.pdf?ua=1. [Last accessed on 2020 Nov 07].  Back to cited text no. 9
    
10.
Das N, Narnoli S, Kaur A, Sarkar S, Balhara YP. Attitude to telemedicine in the times of COVID-19 pandemic: Opinion of medical practitioners from India. Psychiatry Clin Neurosci 2020;74:560-2.  Back to cited text no. 10
    
11.
Malhotra N, Sakthivel P, Gupta N, Nischal N, Ish P. Telemedicine: a new normal in COVID era; perspective from a developing nation. Postgrad Med J. 2020 Sep 24:postgradmedj-2020-138742. doi: 10.1136/postgradmedj-2020-138742. Epub ahead of print. PMID: 32972962..  Back to cited text no. 11
    
12.
Monitor Tobacco Use and Prevention Policies. Available from: https://www.who.int/tobacco/mpower/publications/en_tfi_mpower_brochure_m.pdf?ua=1guidelines. [Last accessed on 2020 Nov 07].  Back to cited text no. 12
    



 
 
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  [Table 1], [Table 2]



 

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