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DOI: 10.1055/a-1503-1744
COVID-19 und Rauchen
Ein Positionspapier der Task Force Tabakentwöhnung der DGPCOVID-19 and SmokingA Position Paper by the DGP Taskforce for Smoking CessationZusammenfassung
Tabakrauchen geht mit einem erheblichen Gesundheitsrisiko einher. Die Mortalität durch Tabak-assoziierte Erkrankungen wird durch die WHO für das Jahr 2020 auf über 8 Millionen Menschen weltweit geschätzt. Tabakrauchen ist auch ein seit langem gut belegter Risikofaktor für unterschiedliche pulmonale Infektionserkrankungen. Somit stellt sich die Frage, ob Rauchen das Auftreten und schwere Verläufe einer SARS-CoV-2-Infektion begünstigt.
Um diese Frage zu beantworten, haben wir einen narrativen Review durchgeführt. Insbesondere haben wir systematisch nach Metaanalysen zum Thema gesucht, die im Jahr 2021 publiziert wurden. Sieben Meta-Analysen wurden identifiziert. Tabakrauchen war dabei mit einem erhöhten Risiko schwerer Krankheitsverläufe (Bereich des Odds Ratios/ORs von aktiven Rauchern vs. Nierauchern 1,55–2,19 und von ehemaligen Rauchern vs. Nierauchern 1,20–2,48) und einer erhöhten Krankenhaussterblichkeit (Bereich der ORs von aktiven Rauchern vs. Nierauchern 1,35–1,51 und ehemaligen Rauchern vs. Nierauchern 1,26–2,58) an COVID-19 assoziiert. Dabei sind offenbar neben einer direkten pulmonalen Schädigung durch das Rauchen v. a. Tabak-assoziierte Begleiterkrankungen und damit die kumulative Tabakexposition für schwere Verläufe verantwortlich. Für das Infektionsrisiko ist die Datenlage nicht eindeutig, auch wenn eine britische Studie mit über 2,4 Millionen Personen eine Assoziation von Tabakrauchen und COVID-19-typischen Symptomen beschreibt. Für die E-Zigarette und Tabakerhitzer stehen weniger Daten zur Verfügung. Laborexperimentelle und erste klinische Daten legen aber auch für diese Nikotinprodukte einen ungünstigen Einfluss auf SARS-CoV-2-Infektionen nahe.
Gerade während der SARS-CoV-2-Pandemie mit stark begrenzten therapeutischen Möglichkeiten für COVID-19 ist es wichtig, aktive Raucher auf die Gefahren des Konsums hinzuweisen und eine Entwöhnungsbehandlung zu ermöglichen, die auf einer breiten Evidenz und Erfahrung fußt. In Deutschland gibt es dabei erheblichen Nachholbedarf. Erforderlich ist daher eine Regelung, die die Kostenübernahme für wissenschaftlich gesicherte Methoden der Tabakentwöhnung durch die gesetzliche Krankenversicherung ermöglicht.
Abstract
Tobacco smoking is associated with severe health risks. In 2020, the WHO estimated that 8 million people have died due to smoking. Furthermore, smoking tobacco is a well-known risk factor for various infectious pulmonary diseases. The question raised, whether smoking is facilitating SARS-CoV-2-infections and increases adverse outcomes of COVID-19. To answer these questions a narrative review was conducted, finally including 7 systematic reviews with meta-analyses published in January and February 2021. Tobacco smoking was associated with an increased COVID-19 disease severity (odds ratio range of active vs. never smokers 1.55–2.19 and former vs. never smokers 1.20–2.48) and an increased COVID-19 in-hospital mortality (odds ratio range of active vs. never smokers 1.35–1.51 and former vs. never smokers 1.26–2.58). Beside immediate pulmonary toxic effects through active smoking, the cumulative livelong tobacco exposition and subsequent tobacco-associated diseases seem to predominantly predict adverse outcomes in patients with COVID-19. Data regarding an increased risk of infection among smokers is conflicting. However, a large observational study from England with 2.4 million persons reported an association between tobacco smoking and typical symptoms of COVID-19. For e-cigarettes and vaping less data exist, but experimental and first clinical investigations also suggest an increased risk for adverse outcomes for their use and SARS-CoV-2 infections. Especially during the current SARS-CoV-2 pandemic with limited therapeutic options it is particularly important to advise smokers of their increased risks for unfavourable COVID-19 outcomes. Evidence based support for smoking cessation should be offered. In Germany, the existing and well-established methods to support tobacco cessation need to be reimbursed by statutory health insurances.
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Raucher haben schwerere COVID-19-Krankheitsverläufe und höhere Sterblichkeit.
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Raucher müssen über die besonderen Risiken schwerer Verläufe informiert werden.
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Abhängigen Rauchern muss ein barrierefreier Zugang zu Behandlungs-Maßnahmen mit dem Ziel der Tabakabstinenz zugänglich gemacht werden.
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Die Kosten der Behandlung müssen von der gesetzlichen Krankenversicherung getragen werden.
Publication History
Article published online:
26 May 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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