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Coronavirus (COVID-19) and smoking - information for health professionals

Evidence is building to suggest that people who smoke are at higher risk of COVID-19 infection. There is strong evidence that people who smoke are at higher risk of acute respiratory tract infections generally, including bronchitis and influenza.

Are people who smoke at higher risk of COVID-19?

The evidence to suggest that people who smoke are at higher risk of COVID-19 has been inconsistent, but a recent key study found that people who smoke have a three-fold higher risk of COVID-19 infection. There is strong evidence that people who smoke are at higher risk of acute respiratory tract infections generally, including bronchitis and influenza. Smoking increases the incidence, duration and severity of viral respiratory infections and has also been found to increase the risk of pneumonia.  Read more at Tobacco in Australia.

The hand-to-mouth action of smoking and vaping might also make people who smoke or vape more vulnerable to COVID-19, as they are touching their face and mouth more often.

There is emerging evidence to suggest the coronavirus may be spread via aerosols. This raises the possibility that the virus could be transmitted through exhaled tobacco smoke and e-cigarette aerosols (in the air and as they settle on surfaces), although more research is required to support this.

Sharing any type of tobacco or smoking product (for example, cigarettes, e-cigarettes or shisha/waterpipes) can also increase the risk of spreading COVID-19.

Are people who smoke more likely to have worse outcomes, if they are diagnosed with COVID-19?

The evidence to suggest that smoking is a risk factor for the severity of COVID-19 disease is inconsistent. Some data indicate that people who have previously smoked may be at greater risk than people currently smoking.

One study showed that people who smoke are 80% more likely to be admitted to hospital and significantly more likely to die from COVID-19 than people who do not smoke. Smoking compromises immune system functioning, both systemically and locally in the lung. Smoking impairs mucociliary clearance, increases inflammatory responses and causes cellular changes in the lining of the airway. 

There is also evidence that people with co-morbidities such as cardiovascular disease and cancer (which are caused by smoking, in many cases) are more likely to experience severe complications of COVID-19. 

Read more here.

Are people who vape more likely to experience symptoms, if they are diagnosed with COVID-19?

A recent study demonstrated that people who vape experience a (statistically significant) higher frequency of COVID-19 related symptoms when compared with age and gender matched non-vapers. Symptoms include chest pain and tightness, chills, myalgia and light-headedness. The study also found that people who vape and smoke tobacco (‘dual users’), and who test positive for COVID-19, experience a significantly higher occurrence of dyspnoea and emergency department visits.

How long do people have to stop smoking for to reduce their risk of complications from COVID-19?

This is not currently known for COVID-19 specifically, but it is well-established that stopping smoking improves general lung health. For example, quitting improves mucociliary clearance in the nose after two weeks, and in the lungs after three months. Rates of bronchitis and pneumonia also decrease, compared to continued smoking.

Are people who smoke more likely to get blood clots after receiving the COVID-19 AstraZeneca vaccine?

No, smoking will not lead to a higher chance of getting blood clots after receiving the AstraZeneca vaccine.  

The blood clots associated with the AstraZeneca vaccine are called Thrombosis with thrombocytopenia syndrome (TTS). TTS has a different mechanism to most other blood clotting conditions and is triggered by the immune system’s response to the COVID-19 AstraZeneca Vaccine. It results in both thrombosis and low platelet levels. In the most cases, pathological antibodies against platelet factor 4 (PF4), a protein released from platelets, are detected.  

Therefore, although smoking causes sticky blood, which can lead to the formation of blood clots, the two are not related. 

For more information, read the Joint statement from the Australian Technical Advisory Group on Immunisation (ATAGI) and the Thrombosis and Haemostasis society of Australia and New Zealand (THANZ) on Thrombosis with Thrombocytopenia Syndrome (TTS) and the use of COVID-19 Vaccine AstraZeneca here.

Are COVID vaccines less effective in people who smoke?

It is unclear whether smoking reduces the effectiveness of COVID-19 vaccines.  

A recent Italian study found that smokers had significantly lower titres of SARS-CoV-2 antibodies 1-4 weeks after the second dose of the Pfizer vaccine, compared to non-smokers. Although it is currently impossible to determine whether a lower number of SARS-CoV-2 antibodies leads to a higher likelihood of developing COVID-19, neutralising antibodies correlate with protection against several viruses including SARS-CoV-2, so this may well be the case. 

A recent study of healthcare workers who had received two doses of the BNT162b2 COVID-19 vaccine (Pfizer/BioNTech) found older age and smoking (adjusting for age) were associated with significantly lower antibody concentrations three months after receiving the second dose. Current smokers also had significantly lower antibody concentrations following vaccination compared to ex-smokers. The authors suggest that this indicates smoking cessation prior to vaccination may improve efficacy of BNT162b2 vaccine.

Given that people who smoke may be more severely affected by COVID-19, people who smoke should be strongly recommended to get the COVID-19 vaccine when it becomes available to them.

Is it still safe to start, or continue to use, nicotine replacement therapy (NRT) and other smoking cessation pharmacotherapies?

For people who smoke, pharmacotherapies like nicotine replacement therapy (NRT) can effectively reduce cravings and manage withdrawal symptoms.  When combined with behavioural intervention from Quitline, these pharmacotherapies give people the best likelihood of successfully quitting.

There is no evidence that COVID-19 has an impact on the safety and effectiveness of NRT or other pharmacotherapies. There is no reason why patients cannot commence or continue to use them to support a quit attempt, as clinically appropriate.

How can health professionals best support people who smoke?

Stopping smoking is one of the best things a person can do for their health; COVID-19 provides a great teachable moment. Health professionals are well-placed to provide people who smoke with the support they need to quit. Health professionals can help people who smoke to quit by referring to Quitline and prescribing, or facilitating access to, smoking cessation pharmacotherapy.

Quit has developed online brief advice training for health professionals. It’s all about connecting people who smoke with best practice tobacco dependence treatment; Quitline and pharmacotherapy. 

Visit to register for the online training today. 

1 in 33 conversations in which a health professional advises a patient to quit smoking will result in them successfully quitting. Health professionals can provide smoking cessation brief advice to people who smoke, which involves three steps: 

  • Ask people about their smoking status.
  • Advise all people who smoke to quit in a clear, non-confrontational and personalised way, and advise of the most effective way to quit.
  • Help all people who smoke to quit, by referring to Quitline and prescribing, or helping people to access, smoking cessation pharmacotherapy (such as nicotine replacement therapy). 

There is also an Aboriginal Quitline for people who smoke identifying as Aboriginal and Torres Strait Islander. For more information about brief advice, visit:

Quit has also developed a Quit Tips Hub for people who want to stop smoking during the coronavirus (COVID-19) pandemic and flu season. Visit Quit Tips Hub to see what is available for consumers.

Last updated 23/02/2022

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