# COVID-19 symptoms associated with smoking and vaping tobacco and cannabis: A cross-sectional analysis

## TL;DR

This study found that people who smoke or vape nicotine or cannabis report more frequent and severe respiratory symptoms, including dyspnea, compared to non-users during the pandemic.

## Contribution

The study is among the first to analyze the association between nicotine and cannabis use and self-reported respiratory symptoms in a digital symptom checker.

## Key findings

- Current vaping and co-use of nicotine and cannabis were associated with higher odds of dyspnea.
- Smoking and vaping were linked to more frequent constitutional, respiratory, and gastrointestinal symptoms.
- Including tobacco and cannabis use in symptom checkers may improve risk stratification for respiratory illnesses.

## Abstract

Characterize symptoms observed among people using nicotine and/or cannabis compared to non-users using an institutional respiratory illness symptom checker.

Cross-sectional study (April 2020–August 2021) using University of California San Francisco (UCSF) COVID-19 & Flu Symptom Checker online self-triage tool measuring current tobacco and cannabis use, symptom prevalence and associations with self-reported severe dyspnea, using multivariable logistic regression.

Excluding those with emergent symptoms requiring immediate medical evaluation, of 10,904 patients, 729 (6.7%) self-reported current nicotine or cannabis use. People smoking and/or vaporizing nicotine or cannabis reported constitutional, ear/nose and throat, respiratory, and gastrointestinal symptoms more frequently than non-users. Current vaping (aOR = 1.89, 95% CI 1.23, 2.81) and co-use of nicotine/cannabis (aOR = 2.00, 95% CI 1.26, 3.09) were associated with higher odds of dyspnea, adjusting for comorbidities and demographic factors.

People using nicotine or cannabis products had increased frequencies of self-reported COVID-19 symptoms and dyspnea. Current vaporizer use may not be associated with a difference in self-reported respiratory symptoms compared to smoking tobacco. Including tobacco and cannabis use in symptom checkers may enhance risk stratification and clinical decision-making during future respiratory virus outbreaks.

•Tobacco and cannabis use is rarely included in respiratory symptom checkers•Both smoking and vaping modes of use were associated with severe symptoms (dyspnea)•Co-use of both nicotine and cannabis was associated with dyspnea•Using vaporizers for nicotine or cannabis may not decrease respiratory symptoms•Including smoking/vaping status may improve digital triage for respiratory illness

Tobacco and cannabis use is rarely included in respiratory symptom checkers

Both smoking and vaping modes of use were associated with severe symptoms (dyspnea)

Co-use of both nicotine and cannabis was associated with dyspnea

Using vaporizers for nicotine or cannabis may not decrease respiratory symptoms

Including smoking/vaping status may improve digital triage for respiratory illness