Introduction:

With the spread of the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), questions about the risk factors that influence the coronavirus disease 2019 (COVID-19) have emerged. A widely debated issue has been the potential effect of smoking on SARS-CoV-2 infection rates and the clinical consequences of COVID-19.

Objective:

To elucidate the implications of smoking in the context of COVID-19.

Development:

In the literature consulted, several pathophysiological mechanisms that support the deleterious effect of smoking in the context of COVID-19 were identified: upregulation of angiotensin-converting enzyme 2; increased expression/activity of transmembrane serine protease 2, cathepsin B/L and furin; immunoinflammation and immunosuppression; upregulation of phosphodiesterase 4; encephalic hemovascular alterations; and morphofunctional modifications of the lung parenchyma.

Conclusions:

Smoking has a deleterious effect on patients bearing COVID-19. In this harmful association, there are pathophysiological mechanisms that may make smokers -active or passive ones- more vulnerable to SARS-CoV-2 infection or more likely to present with an unfavorable evolution once they have developed COVID-19.

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