Coronavirus: why are smokers more susceptible to COVID-19?

Coronavirus: why are smokers more susceptible to COVID-19?

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COVID 19: Smoking is the greatest risk factor - but why?

Smoking is often mentioned first among the risk factors for severe COVID-19 diseases, triggered by the new coronavirus SARS-CoV-2. So far, this was thought to be due to existing lung damage, but a recent study has discovered another explanation at the cellular level.

"Smokers and patients with chronic obstructive pulmonary disease (COPD) increasingly express the ACE2 receptor in their respiratory tract, via which SARS coronaviruses get into the cells," reports the Deutsche Ärzteblatt of the new study results. This could explain the increased risk of severe COVID-19 courses. The study was published in the European Respiratory Journal.

Smokers with elevated ACE-2 values

It is known that the ACE-2 receptor forms the entrance gate on the surface of the lung cells, via which the coronavirus can penetrate into the lung cells and cause an infection. The research team around Dr. Janice Leung at the University of British Columbia and St. Paul’s Hospital in Vancouver (Canada) therefore examined samples from the lung tissue of 21 COPD patients and 21 people without COPD and checked the ACE-2 concentration. They found not only higher ACE-2 values ​​in COPD patients, but especially in those who were active smokers.

They also checked their results against two existing study groups with a total of 249 people, some of whom were non-smokers, some current smokers and some former smokers. It was found that the ACE-2 values ​​were higher for current smokers, but lower for non-smokers and former smokers.

Stop smoking to protect against the corona virus?

"We found that patients with COPD and people who still smoke have higher ACE-2 levels in their airways, which could put them at higher risk of developing serious COVID-19 infections," emphasizes Dr. Janice Leung. Furthermore, it had been shown that "former smokers had similar levels of ACE-2 as people who had never smoked." An immediate quit smoking could probably also help to protect against COVID-19. (fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters


  • Deutsches Aerzteblatt international: COVID-19: Why smokers and COPD patients are more susceptible (published April 9th, 2020),
  • Janice M. Leung, Chen X. Yang, Anthony Tam, Tawimas Shaipanich, Tillie-Louise Hackett, Gurpreet K. Singhera, Delbert R. Dorscheid, Don D. Sin: ACE-2 Expression in the Small Airway Epithelia of Smokers and COPD Patients : Implications for COVID-19; in: European Respiratory Journal (published April 8, 2020), European Respiratory Journal
  • European Respiratory Society: Higher levels of coronavirus 'entry point' enzyme in lungs of COPD patients and smokers (published April 9th, 2020),

Video: Are Smokers Less Likely To Get COVID-19? What Doctors Say (July 2022).


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