Smoking adversely affects treatment response, outcome and relapse in tuberculosis

Abstract

The impact of smoking on tuberculosis outcome was evaluated in a territory-wide treatment programme.16 345 consecutive patients undergoing chemotherapy for active tuberculosis in government chest clinics in Hong Kong from 2001 to 2003 were followed up prospectively for 2 years for treatment outcome and subsequently tracked through the territory-wide tuberculosis notification registry for relapse until the end of 2012.Smoking was associated with more extensive lung disease, lung cavitation and positive sputum smear and culture at the baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Both categories of smokers were significantly less likely to achieve cure or treatment completion within 2 years. Overall, 16.7% of unsuccessful treatment outcomes were attributable to smoking, with the key contributor being default in current smokers and death in ex-smokers. Among successful treatment completers, there was a clear gradient (hazard ratios of 1.00, 1.33 and 1.63) of relapse risk from never-smokers to ex-smokers and current smokers, with an overall population attributable risk of 19.4% (current smokers: 12.2%; ex-smokers: 7.2%).Smoking adversely affects baseline disease severity, bacteriological response, treatment outcome and relapse in tuberculosis. Smoking cessation likely reduces relapse and secondary transmission. @ERSpublications Smoking adversely affects treatment response in TB. Smoking cessation reduces relapse and secondary transmission.

Tobacco and tuberculosis: could we improve tuberculosis outcomes by helping patients to stop smoking?

“…The mortality rate during treatment was not different between smokers and nonsmokers, in contrast to the study by LEUNG et al [14].…”

“…The first study, by LEUNG et al [14], conducted in a large population of tuberculosis patients observed in Hong Kong, China, between 2001 and 2003, and followed for 10 years, confirmed that smokers with tuberculosis had a more severe clinical and radiological presentation, more frequent sputum positivity at presentation and after 2 months of treatment, a lower rate of success and, if successfully cured, a higher risk of relapse. Surprisingly, these findings were observed in spite of the fact that smokers were offered brief advice for smoking cessation, and referral for further nonpharmacological and pharmacological intervention if needed.…”

Tuberculosis in a Portuguese Cohort

“…11,12 Some patients have characteristics that put them at risk of acquiring TB. 1,8 Some factors recognized as risk factors for TB are smoking [19][20] , presence of any immunosuppression status (use of immunosuppressive drugs, cancer or HIV infection) 10,[21][22][23][24][25][26][27] , younger or older age 28,29 , migrant status [30][31][32] , inmate status 31,33 , homelessness or institutionalization 31,34,35 , close contact with TB-infected patients 36,37 , drug use 38 , alcoholism 39 , malnutrition 40 , diabetes [41][42] and other chronic comorbidities [43][44][45] . Obesity 46 and female gender 47 seem to reduce the risk of acquiring TB.…”

What Factors May Influence Epidemiological Situation of Tuberculosis in Poland and in the World?

“…They usually present with more advanced lesions [63] and more often suffer from www.pneumonologia.viamedica.pl the disease recurrence [64]. Cigarette smokers are also a at greater risk of death from tuberculosis [65].…”