Risk for COVID-19 infection in patients with tobacco smoke-associated cancers of the upper and lower airway
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REVIEW ARTICLE
Risk for COVID‑19 infection in patients with tobacco smoke‑associated cancers of the upper and lower airway Oreste Gallo1 Received: 2 July 2020 / Accepted: 22 October 2020 © The Author(s) 2020
Abstract Purpose Cancer patients are regarded as a group at risk for both COVID-19 infection and severe clinical course because of advanced age, comorbidities and iatrogenic immune impairment. Among them, patients with cancer of the upper and lower airways share other risk factors, mostly related to tobacco-smoke exposure, including male gender, airway epithelial damages, chronic obstructive respiratory disease (COPD), cardiovascular and cerebrovascular diseases. Clinical and pathophysiological factors shared by these conditions are reviewed. Methods Review of the published literature since the beginning of 2020. Results COVID-19 is a respiratory infectious disease and SARS-CoV-2 replication and shedding occurs in nasal and bronchial epithelial respiratory cells through the interaction with ACE2 and TMPRSS2 receptors, both overexpressed in smokers and former smokers. Tobacco-smoke airway exposure is also characterized by a chronic inflammation with activation of inflammatory cells and cytokine release including interleukin-6 (IL-6). A high release of cytokine in response to viral infection is documented in COVID-19 patients with adverse clinical outcomes and IL-6 is a key element of the cytokine storm syndrome leading to multi-organ damage. Conclusions Patients with cancers of the upper and lower airways might be at increased risk of infection, morbidity and mortality from COVID-19 also because of tobacco exposure, a key factor in triggering inflammation, immunity and cancer. Keywords COVID-19 · Tobacco smoke · Interleukin-6 · Head neck cancer · Lung cancer
Introduction COVID-19 is a coronavirus outbreak that initially appeared in Wuhan, Hubei Province, China, in December 2019, but it has already evolved into a pandemic spreading rapidly worldwide. As of 14 October 2020, a total number of 31 million cases of COVID-19 have been reported worldwide, including more than 1,000,000 deaths, the majority of which have been reported in Europe, USA, India and Brasil [1]. However, as the pandemic is still unfortunately under progression, few data are available regarding potential risk and prognostic factors in COVID-19 population [2]. Among them, smoking history has been correlated with a higher incidence and severity of SARS-CoV-2 infection [2, 3].
* Oreste Gallo [email protected] 1
Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50139 Florence, Italy
A Chinese study published in February 2020 based on a sample of 1.099 confirmed cases of COVID-19, comparing smokers and non-smokers, among 172 patients with severe symptoms, 16.9% were current smokers and 5.2% were former smokers, in contrast with non-complicated cases where 11.8% were current smokers and 1.3% were former smoker [2]. A higher risk of respiratory infection and mortality in smokers has been reported in p
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