Re: Response to the emerging novel coronavirus outbreak
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
Mr J.P. DAVIES MB BCh FRCS FRCS(Orth)
Trauma & Orthopaedic Consultant
19th of March 2020
The Royal Glamorgan Hospital
Conflict of Interest: None
Competing interests: No competing interests