Intoroduction/Objective The objectives of our study were to determine the impact of smoking on clinical characteristics, the scope of radiological severity, and treatment outcome of patients with pulmonary tuberculosis (PTB). Method This prospective study included patients suffering from PTB treated at the Pulmonology Department of the Clinical Hospital Center in Kosovska Mitrovica in the period between 2010 and 2016. Results Among smokers suffering from PTB there were significantly more males (p = 0.05) between 30 and 49 years of age (p < 0.001). There was significantly more alcohol consumption present in smokers (p < 0.001), whose social factor for developing PTB (p = 0.002) was more expressed. A more severe form of PTB with cavitation was more common in smokers (38.8%), while a milder, parenchymatous, unilateral PTB was present in non-smokers (31.8%). Extensive X-ray changes were more common in smokers (p = 0.002). Relapse of the disease was more prevalent in smokers (p = 0.05). In multivariate logistic regression, the risks of being a smoker included years of age: 30-39 [odds ratio (OD) = 18.11], 40-49 (OR = 19.66), and 50-59 (OR = 9.06), and alcohol consumption habits (OR = 9.32). Conclusion Smokers were more often afflicted with sputum-positive PTB, had extensive radiological changes, and the relapse of the disease was more common. Smokers were mostly middle-aged, with alcohol consumption habits, and constructed a group of patients whose habits were a critical factor for the eradication of tuberculosis.