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The nAChRs receptors are widely distributed throughout the central nervous system and activate acetylcholine neurotransmitter signaling pathways, while nAChRs can be easily activated by nicotine (Figure 2 ( Even if upregulation of ACE2 in the initial stage of tobacco exposure helps prevent acute lung injury, there is no doubt that upregulation of ACE2 expression can increase COVID-19 susceptibility, and long-term tobacco exposure can cause an imbalance of the bodys RAS system, leading to a series of changes

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In addition, other studies reported that managing emotions and mood was also a barrier 10,37 , which also aligns with our findings