Smoking and coronavirus (COVID-19): time to quit

Sarah Chapman and Selena Ryan-Vig share evidence from a Cochrane Special Collection, COVID-19: Effective options for quitting smoking during the pandemic. Page last updated: 14 January 2022 and last checked 26 June 2023.

Take-home points

Smoking increases the risk of getting acute respiratory infections and of being more severely affected, as does exposure to second-hand smoke. The Cochrane Special Collection, COVID-19: Effective options for quitting smoking during the pandemic, pulls together evidence including Cochrane Reviews on nicotine replacement, behavioural support such as telephone, internet and text messaging programmes, and gradual quitting. The Cochrane Reviews in the Special Collection focus on interventions which do not rely on in-person support, or face-to-face contact with health practitioners.

It’s a harsh reality that if you’re a smoker you’re more likely to get acute respiratory infections and have a higher risk of those infections becoming severe. The increased risks may come from the damage smoking does to your lungs and the transmission of a virus from hand to mouth while you’re smoking. Exposure to second-hand smoke also increases the risk of getting acute respiratory infections. Given that we are now facing an unprecedented threat from the coronavirus (COVID-19), an acute respiratory infection, there has never been a better time to stop, and the World Health Organization is urging people to do so.

 Smoking in England is on the decline

There is evidence that if a smoker can quit for 28 days, they are five times more likely to quit for good. In the context of the pandemic, Public Health England has been encouraging people who smoke to put their lungs first, strengthen their immune system and breathe easier.

There was a rare bit of good news in 2020, with smoking among adults in England at a record low (just under 14%). There was an increase of nearly a quarter (22%) in quit attempts compared to 2019 and an increase of almost two-thirds in the quitting success rate from 14% to 23%. Action on Smoking and Health (ASH) reported in July 2020 that a million people had quit since the start of the pandemic in Britain, with many more young people quitting than older ones.

Evidence-based support to quit smoking

But quitting is hard for many, and perhaps particularly so at a time of great stress and when many of our routines have been disrupted. What’s more, we still may be facing difficulties or delays accessing face-to-face, in-person support for help with things like stopping smoking. However, there are other options for quitting, with evidence to support them.

Cochrane Tobacco Addiction has put together a Special Collection of reviews which provide the best available evidence to inform your decisions on ways you might try to quit. The Cochrane Reviews focus on interventions which do not rely on in-person support, or face-to-face contact with health practitioners.

We also have some mini infographics (below), giving you the key information from some of these Cochrane Reviews, and some blogs.

Cochrane author, Nicola Lindson from the Nuffield Department of Primary Care Health Sciences, University of Oxford, UK, said “If one method doesn’t work, don’t be discouraged – evidence shows some people need to try to quit many times before successfully doing so. Just because you haven’t been able to quit before, doesn’t mean you won’t be able to now.”

If you can, this is a great time to quit.

Nicotine replacement therapy versus control for smoking cessation

Nicotine replacement therapy (NRT) in all licensed forms (gum, lozenges, patches, sprays, inhalers and tablets/lozenges) increases the chances of successfully quitting smoking (high-certainty evidence). Side effects from using NRT were related to the type of product, including skin irritation from patches and irritation to the inside of the mouth from gum and tablets. These reactions were usually not severe enough to prompt people to stop taking the treatment. Chest pains and palpitations were rare and serious adverse events were extremely rare. Cochrane Review (published May 2018); 136 studies with 64,640 people who smoke cigarettes included in the main analysis, comparing NRT with placebo or no NRT.

Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation

There is reliable Cochrane evidence that people who use a combination of nicotine patches together with another type of nicotine replacement therapy (NRT) (such as gum or lozenges) are more likely to quit smoking than if they used one type of NRT alone Starting NRT before ‘quit day’ (the day you stop smoking), probably improves the chance of successfully quitting, compared with starting NRT after you've given up cigarettes Most of the available studies have not looked into the safety of NRT. However, those that have suggest that unwanted effects are rare and that NRT is generally well-tolerated.

Find out more in our blog: Nicotine replacement therapy (NRT): evidence on help to quit smoking

Mobile phone text messaging and app-based interventions for smoking cessation

Text messaging programmes designed to help people quit smoking probably improve the chance of successfully quitting compared with minimal support (moderate-certainty evidence). They also probably improve the chance of quitting smoking when added to other quit-smoking interventions compared with those interventions alone (moderate-certainty evidence). The effect of programmes delivered through smartphone apps, compared with less intensive support, is uncertain (very low-certainty evidence). The review did not include information about possible harms of the interventions. Cochrane Review (published October 2019); 26 studies with over 33,000 people who smoke. Studies compared quit rates in people who received support from text messages or smartphone apps, either alone or with other quit-smoking support interventions, with those who did not.

Compared with receiving no help at all, written self‐help materials probably help more people to stop smoking for at least six months (moderate-certainty evidence). There was no information about whether print-based self-help interventions have any harms. Cochrane Review (published January 2019); 75 studies were found and 11 of these, with over 13,000 people, provided data for the main comparison. This compared print‐based self‐help with receiving no materials. Participants were not selected for having a particular interest in quitting smoking.

Telephone counselling for smoking cessation

Multiple sessions of telephone counselling for smokers who call quitlines probably increase the chances of quitting smoking compared with provision of self-help materials or brief counselling in a single call (moderate-certainty evidence). Receiving telephone calls from counsellors or other healthcare providers probably also increases the chances of quitting for people who do not call quitlines (moderate-certainty evidence). There was no information about harms. Cochrane Review (published May 2019); 104 studies with 111,653 smokers, mostly adults from the general population but some pregnant women, teenagers and people with long term conditions. Studies explored the effectiveness of different types of telephone counselling, including for people who called ‘quitlines’ and others who received calls from counsellors or other healthcare providers.

Smoking reduction interventions for smoking cessation

It is uncertain how cutting down before quitting smoking compares with no treatment (very low-certainty evidence). People who cut down first are probably equally likely to successfully quit as those who try to quit all at once (moderate-certainty evidence). People may be more likely to quit by cutting down first when they use a stop‐smoking medicine as well (low-certainty evidence). However this is probably only true when using varenicline or a type of fast‐acting nicotine replacement therapy (NRT) such as nicotine gum or lozenge (moderate-certainty evidence) and may not be true when using a nicotine patch, combination NRT or bupropion as an aid (low- or very low‐quality evidence). There is not enough information about whether cutting down before quitting has negative effects such as cravings, difficulty sleeping, low mood or irritability.  Cochrane Review (published September 2019); 51 studies with over 22,000 people who smoked tobacco. Studies compared: 1) cutting down with no treatment; 2) cutting down with quitting all at once; 3) cutting down while using a stop-smoking medicine with cutting down alone.

We’ve also blogged about this: What is the best way to stop smoking – should I stop suddenly or cut down first?

There is also a review on Internet-based interventions for smoking cessation.

Evidently Cochrane blogs


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References (pdf)

Sarah Chapman and Selena Ryan-Vig have nothing to disclose.

Smoking and coronavirus (COVID-19): time to quit by Sarah Chapman and Selena Ryan-Vig

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

1 Comments on this post

  1. It is a great blog post about .I am always read your blog helpful and informative tips. I like it thanks for sharing this information with us .

    Rctcpgi / Reply

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