Premorbid cigarette smoking is an independent risk factor for reduced survival in individuals with amyotrophic lateral sclerosis (ALS), according to new research from Italy. In 650 patients with ALS, premorbid smoking showed an inverse correlation with median survival after diagnosis. Importantly, this relationship persisted after stratification of the cohort for chronic obstructive pulmonary disease, suggesting that the adverse effects of smoking were not solely attributable to respiratory failure.