Prevalence of Smoking and Its Impact on Treatment Outcomes in Newly Diagnosed Pulmonary Tuberculosis Patients: A Hospital-Based Prospective Study

Abstract

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.

The impact of smoking on clinical characteristics and treatment outcome of patients with pulmonary tuberculosis

“…In our patients, in addition to severe clinical manifestations of the disease, poorer treatment outcomes and relapse were significantly more frequent. This is consistent with other studies, where relapse of TB was recorded in 10.4% of patients [30]. For example, in a survey conducted in Georgia, smokers had a 70% poorer outcome than nonsmokers [22].…”

“…For example, in a survey conducted in Georgia, smokers had a 70% poorer outcome than nonsmokers [22]. Patients experiencing extensive changes on the lung parenchyma often suffer from relapses and are at increased risk of mortality [29,30]. Among our patients, there were more death outcomes in smokers suffering from TB.…”

Management of hospitalized drug sensitive pulmonary tuberculosis patients during the Hajj mass gathering: A cross sectional study

“…Around 28% (8/29) of the TB cases reported being current smokers and a similar proportion (5/18) indicated that they did smoke in the past. This is higher than that reported in another study among Hajj pilgrims with TB (13.3%) [7] but lower than figures from some international reports [15,16]. Other risk factors for TB such as visit to, or residence in high-burden countries and occupational exposure were uncommon among TB patients in the study and so was previous Hajj or Umrah performance.…”

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

“…Eight studies were conducted in urban areas and two in rural areas (Table K in S4 Text). All of the studies are high-quality with regard to sampling strategy; however, two of the studies did not report the proportion of the cohort that was lost to follow-up during the study period [72,73]. Two of the studies describing TB outcomes among HIV-infected individuals are very low in quality because they have a sample size of <100 patients (Table K in S4 Text) [51,74].…”