Cigarette Smoking and Infection
Abstract
BACKGROUND: Infectious diseases may rival cancer, heart disease, and chronic lung disease as sources of morbidity and mortality from smoking. We reviewed mechanisms by which smoking increases the risk of infection and the epidemiology of smoking-related infection, and delineated implications of this increased risk of infection among cigarette smokers. METHODS: The MEDLINE database was searched for articles on the mechanisms and epidemiology of smoking-related infectious diseases. English-language articles and selected cross-references were included. RESULTS: Mechanisms by which smoking increases the risk of infections include structural changes in the respiratory tract and a decrease in immune response. Cigarette smoking is a substantial risk factor for important bacterial and viral infections. For example, smokers incur a 2- to 4-fold increased risk of invasive pneumococcal disease. Influenza risk is severalfold higher and is much more severe in smokers than nonsmokers. Perhaps the greatest public health impact of smoking on infection is the increased risk of tuberculosis, a particular problem in underdeveloped countries where smoking rates are increasing rapidly. CONCLUSIONS: The clinical implications of our findings include emphasizing the importance of smoking cessation as part of the therapeutic plan for people with serious infectious diseases or periodontitis, and individuals who have positive results of tuberculin skin tests. Controlling exposure to secondhand cigarette smoke in children is important to reduce the risks of meningococcal disease and otitis media, and in adults to reduce the risk of influenza and meningococcal disease. Other recommendations include pneumococcal and influenza vaccine in all smokers and acyclovir treatment for varicella in smokers.
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Smokers are at greater risk of infection.
“Several researchers agree that smokers are at greater risk of infection [48,49].”
From Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic (2021) · cites this paper as [49]
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- Authors
- Arcavi, L., & Benowitz, N. L.
- Affiliations
- Kaplan Medical Center (IL)
- San Francisco General Hospital (US)
- ORCID
- Benowitz, Neal L.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2004-11-08
- Volume
- 164
- Issue
- 20
- Pages
- 2206
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2141249815
- Cited by
- 1,020
- References
- 138
- Citations by year
- 2026: 21 · 2025: 34 · 2024: 48 · 2023: 68 · 2022: 84 · 2021: 122 · 2020: 87 · 2019: 40 · 2018: 40 · 2017: 39 · 2016: 37 · 2015: 42 · 2014: 50 · 2013: 34 · 2012: 50
- FWCI
- 11.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (DA02277, DA 12393, P30DA012393)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Keywords
- cigarette smoking, infectious diseases, invasive pneumococcal disease, influenza, tuberculosis, tuberculosis risk, passive smoking, meningococcal disease, otitis media, immune response, smoking cessation, pneumococcal vaccine, influenza vaccination, varicella, acyclovir, periodontitis, tuberculin skin test
- MeSH terms
- Adult, Aged, Bacterial Infections, Disease Susceptibility, Female, Humans, Male, Middle Aged, Prognosis, Risk Factors, Smoking, Tobacco Use Disorder, Virus Diseases, Causality, Smoking Cessation, Age Distribution, Sex Distribution
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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