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Rapid response to:


Response to the emerging novel coronavirus outbreak

BMJ 2020; 368 doi: (Published 31 January 2020) Cite this as: BMJ 2020;368:m406

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Rapid Response:

Re: Response to the emerging novel coronavirus outbreak

Dear Editor

What is the possible role of Nicotine in acute respiratory failure caused by COVID-19 Infection?

COVID 19 is understood to bind to ACE 2 receptors. It appears to have a disruptive effect on the homeostasis of the Renin Angiotensin System (1). Nicotine is an ACE-agonist. It has been shown to be protective in acute inflammatory reactions in ARDS probably by decreasing inflammatory cytokine production by macrophages and other mononuclear cells (2).

In this new disease smokers seem to have particularly poor outcomes (3). We postulate that at least in chronic smokers, the disruption of the normal Renin Angiotensin System is exacerbated by nicotine withdrawal leading to exacerbation of acute lung injury. We suggest that the simple use of Nicotine patches should be urgently considered and discussed.

1. Attila R Garami. Preventing a Covid-19 Pandemic.(Rapid Response). British Medical Journal 2020;368:m810. 12th of March 2020.
2. Mabley, Jay et al. Nicotine Excerpts and Anti-inflammatory Effect in a Murine Model of acute lung injury. Inflammation 2011, August; 34 (4): 231-237.
3. Chinese Medical Journal. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 Novel Coronavirus DOI: 10.1097/cm90000000000000775

Dr Robert Davies Dr Nerys Conway Mr J P Davies

Dr Robert Davies MB BCh FRCA
Anaesthesia & Critical Care Consultant

Dr Nerys Conway MB BCh FRCP
Acute Medicine Consultant

Trauma & Orthopaedic Consultant

19th of March 2020

The Royal Glamorgan Hospital
South Wales
CF72 8XR

Correspondence to:

Conflict of Interest: None

Competing interests: No competing interests

19 March 2020
Jonathan P Davies
Consultant Trauma Surgeon
Dr Robert Davies, Dr Nerys Conway
The Royal Glamorgan Hospital
The Royal Glamorgan Hospital, Llanrisant, South Wales CF72 8XR