Bring a large pot of salted water to a boil. Add the fettuccine and cook according to package instructions until al dente. Drain and set aside, reserving about 1/2 cup of the pasta water.

Sauté the Sausage and Vegetables

In a large skillet, heat olive oil over medium heat. Add the sliced andouille sausage and cook until browned, about 4-5 minutes. Add the minced garlic and sliced peppers, and sauté for another 3-4 minutes until the peppers are tender.

Cook the Shrimp

Add the shrimp to the skillet and cook until pink and opaque, about 3-4 minutes. Season with salt and black pepper to taste.

Combine with Sauce and Pasta

Pour in the smoked tomato sauce, stir to combine, and let it simmer for 2-3 minutes. Add the cooked fettuccine and reserved pasta water, tossing everything together until well combined.

Serve

Remove from heat and stir in the grated pecorino cheese. Serve immediately, garnished with fresh parsley and additional cheese if desired.