HomePeople who smoke tobacco are at increased risk of TB infection and progression to active TB, likely due to biologic impacts on innate immune responses and social factors related to exposure.207,208 Recent systematic reviews estimate the risk of TB disease to be twice as high in people who smoke compared to nonsmokers.207,209
Smoking may also affect the clinical presentation of TB. Large patient registries from Spain and Hong Kong have demonstrated that people who smoke are more likely to have pulmonary disease, lung cavitation and sputum-smear positivity and are more likely to require hospitalization for TB treatment than are nonsmokers with TB.210,211
Smoking is also associated with worse TB treatment outcomes, including a higher risk of recurrence and increased mortality.211–213 One cohort study found those who smoke more than 10 cigarettes per day are twice as likely to relapse as those who do not currently smoke.214 Additionally, TB is associated with an increased incidence of airway disease after treatment completion, which may compound the adverse effects of smoke exposure and existing airway disease.
TB patients are engaged into medical care for several months and have frequent visits with nursing staff, pharmacists and physicians. This represents a good opportunity to offer help in smoking cessation. A systematic review demonstrated that smoking cessation interventions appear effective in people receiving treatment for TB.215 No controlled trials have examined the impact of smoking cessation interventions affect TB treatment outcomes.216
Good practice statements
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People with TB who smoke tobacco should be offered tobacco cessation interventions during TB therapy.
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People with pulmonary TB who smoke tobacco should be offered pulmonary function testing at the end of treatment.
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