There is growing evidence that tobacco smoking is an important risk factor for tuberculosis (TB). India, with a population of 1.26 billion, has the highest number of both TB patients and smokers. The convergence of these two important health hazards is likely severely affecting India's TB control programs. This study was carried out to determine the prevalence of smoking in newly diagnosed pulmonary TB patients and the impact of smoking on disease outcomes in a tertiary care hospital. All patients newly diagnosed with pulmonary TB as per the Revised National Tuberculosis Program of India (RNTCP) 2013 criteria were enrolled in the study. On the basis of their self-reported smoking status, the participants were classified as never smokers, current smokers, and ex-smokers. Patients were started on anti-TB treatment and were followed for 2 years. Among the 2350 subjects (1,758 males and 592 females), 1,593 patients (67.78%) were never smokers. Current and ex-smokers numbered 757 (32.21%), of which 751 (31.95%) were males and 6 (0.26%) were females. Smoking was associated with more extensive lung disease, lung cavitation, and positive sputum smear and culture results at baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Ex-smokers and current smokers had significantly high rates of defaults, treatment failures, and relapses. The prevalence of smoking is very high in TB patients. Tobacco smoking is associated with a considerably increased risk of advanced and more severe disease in the form of lung cavitations, positive sputum smear and culture results, and slower smear and culture conversion after initiation of treatment. Smoking has a great negative effect on treatment completion, cure rates, and relapse rates in patients with pulmonary TB.

To assess the feasibility and results of screening diabetes mellitus (DM) patients for tuberculosis (TB) and TB patients for DM within the routine health care setting. Prospective observational study carried out within the Diabetes Centre and Pulmonary Medicine Department from February 2012 to September 2012. The screening for active TB in DM and DM in TB patients is followed as per the guidelines of the Revised National Tuberculosis Control Programme and national programmes in India. Total of 307 patients diagnosed with TB during the study period. Among the TB patients 9.77% were smokers, 19.54% were known cases diabetes, and 15.96% were newly diagnosed cases of diabetes. Total of 4,118 diabetes patients were screened for TB in which 111 patients found to have TB. The strengths of this study are that we implemented screening within the routine health system. It is feasible to screen DM patients for TB resulting in high rates of TB detection.

Background:Chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are common and under diagnosed medical conditions in India. Prevalence of these chronic diseases are high both in rural and urban areas. However, exact prevalence of DM in Indian COPD patients in unclear. Co-morbid conditions like DM have great impact on the outcome of COPD in the form of severity, exacerbations, morbidity and mortality. Hence the present study objective was to screen COPD patients for DM.Results:A total of 1662 patients with COPD (Males = 1264, Female = 398) with mean age 58 ± 9.6 were screened for DM. Patients with known history of DM were 353 (21.24%) and were enrolled as Known DM cases. Remaining 1309 (78.76%) patients whose DM status was unclear were screened by random blood sugar (RBS). One-hundred and seventy-one subjects had RBS > 110 mg/dl. About 73 (4.39%) subjects had fasting blood sugar (FBS) > 126 mg/dl. They were considered as Newly Diagnosed DM cases. Total number of DM cases in the study including new and known was 426 (25.63%). Number of patients with deranged FBS (FBS between 110 mg/dl to126 mg/dl) was 84 (5.05%). Among the DM patients with COPD 168 (10.11%) had poor glycemic control with HbA1c > 8. Prevalence of DM in present study was 25.63%.Conclusion:Prevalence of DM in COPD patients in the present study is 25.63% when actively screened in tertiary care hospital. It is feasible and imperative to screen all COPD patients for DM in all health care facilities routinely.

BackgroundChronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including diabetes, hypertension and cardiovascular diseases. As very limited data is available in India, the aim of the present study was to determine the relationship between COPD and the common, chronic comorbid conditions of diabetes mellitus (DM), hypertension (HTN), and cardiovascular diseases (CVD) and also to determine how these affect the clinical course of COPD.MethodsAll the COPD cohorts diagnosed as per Global Initiative for Chronic Obstructive Lung Disease-2013 (GOLD-2013) criteria were screened for DM, HTN, and CVD as per stipulated national and WHO guidelines.ResultsThe prevalence of DM, HTN, and CVD in the 2432 COPD subjects was 25.94%, 37.25%, and 13.93%, respectively. In multivariate analyses, very severe COPD was associated with a higher risk of DM (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2), HTN (OR 1.6, 95% CI 1.4–1.9), and CVD (OR 2.5, 95% CI 1.9–3.0).ConclusionA significant relationship was found between COPD and the presence of comorbid DM, HTN, and CVD. It was also found that subjects with advanced COPD were more likely to have at least two of these conditions and hugely affect the outcome of the disease. These findings suggest that the presence of COPD could provide a rationale to look for other comorbid disease and, conversely, that the presence of DM, HTN, or CVD might be the basis for the assessment of patients for airflow limitation and COPD as the tobacco smoking and advancing age were common risk factors.

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