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Intern Med. 2008;47(24):2117-20. Epub 2008 Dec 15.

The relationship between nicotine dependence level and community-acquired pneumonia in young soldiers: a case control study.

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Department of Pulmonary Diseases, GATA Haydarpasa Training Hospital, Istanbul, Turkey.



Smoking is an important risk factor in the development of community-acquired pneumonia (CAP). This study was designed to investigate the relationship between nicotine dependence level and the development of CAP.


The Fagerstrom test for nicotine dependence (FTND) was performed to measure nicotine dependence level (NDL). Subjects with a Fagerstrom score (FS) of 5 or lower were defined as low dependence level and a FS score of 6 or higher was defined as high dependence level.


The risk of pneumonia development was higher in smokers than in nonsmokers (OR=2.19, 95% CI 1.13-4.23). The pneumonia development risk was 1.91 times higher in the low dependence level group compared to nonsmokers (OR=1.91, 95% CI 0.95-3.83). In the high nicotine dependence level group pneumonia risk was 2.93 times higher than in nonsmokers (OR=2.93, 95% CI 1.34-6.36). We also studied the relationship between CAP and the time to the first cigarette of the day. Risk was the lowest in the smoker group of after 60 minutes and risk ratios increased with decreased time.


In this study, a high nicotine dependence level was found to be a risk factor associated with smoking for CAP development. The time period of the first cigarette after waking up is also important in pneumonia development as well as in the nicotine dependence level.

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