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

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.