Smoking Linked to Alarming Rise in Tuberculosis Relapses and Deaths

A recent groundbreaking study has brought to light concerning connections between smoking and tuberculosis (TB) treatment outcomes. While it's widely recognized that smoking can worsen TB, this comprehensive research delves deeper, offering vital insights into the severity of the issue. The study underscores the critical need to address smoking as a significant contributor to adverse TB outcomes, including recurrence/relapse and mortality during treatment. 

The study results were published in the CHEST journal on August 29, 2023. 

 Tuberculosis (TB) remains a global health concern, and the role of smoking in exacerbating TB treatment outcomes has long been acknowledged. There is limited research on the outcomes of smoking on TB recurrence/relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST). Hence researchers conducted a systematic review and meta-analysis to understand the association of smoking on treatment outcomes of tuberculosis. 

Researchers conducted an extensive search of medical databases, including MEDLINE, EMBASE, and CINAHL, up to November 22, 2021. The objective was to identify epidemiological studies examining the interplay between tobacco use and various TB treatment outcomes. These outcomes ranged from TB relapses to mortality during treatment. Rigorous screening, data extraction, and quality assessments ensured the reliability of the findings. The study employed robust statistical analyses, offering a comprehensive overview of the situation.

Findings: 

• Among the 1,249 records examined, 28 studies met the stringent inclusion criteria for the meta-analyses.
• The outcomes were stark.
• Ever-smoking was found to significantly elevate the risk of TB recurrence and relapse when compared to current smokers, past smokers, and non-smokers. 
  
• Whether individuals were ever smokers, current smokers, or past smokers, the risks were consistently higher compared to those who had never smoked suggesting the destructive impact of smoking on TB outcomes. 
• Individuals who were ever-smokers or current smokers faced a significantly increased likelihood of mortality during TB treatment compared to never and non-current smokers revealing a direct link between smoking and adverse TB outcomes.
• Preliminary findings hinted at a heightened risk of poor TB treatment outcomes among Smokeless Tobacco users when compared to non-users.

This extensive research carries profound implications for public health. It serves as a resounding call to address smoking as a critical factor exacerbating TB outcomes, from relapses to deaths during treatment. The urgent need for the integration of smoking cessation strategies within TB management programs cannot be overstated.

Further reading: Is tobacco use associated with risk of recurrence and mortality among people with tuberculosis? A systematic review and meta-analysis. https://doi.org/10.1016/j.chest.2023.08.021