Tobacco Use Linked to Poor Tuberculosis Treatment Outcomes With Increased Chances Of Recurrence And Mortality

Smoking and tobacco use have long been associated with a range of health risks, and a recent comprehensive study has reinforced the link between tobacco use and unfavourable tuberculosis (TB) treatment outcomes. While the detrimental effects of smoking on general health are well-known, this study published in CHEST by Aishwarya L V and colleagues sought to systematically summarize the evidence regarding tobacco use and its impact on TB treatment outcomes, including TB recurrence/relapse and mortality during treatment.

Researchers conducted a thorough search of MEDLINE, EMBASE, and CINAHL databases, including studies available up to November 22, 2021. They specifically looked for epidemiological studies that reported associations between tobacco use and at least one TB treatment outcome. A meticulous review process, including screening, data extraction, and quality assessments, was undertaken. The study also included random-effects meta-analyses for the two primary review outcomes: TB recurrence/relapse and mortality-during-treatment. Any heterogeneity in the data was explored using subgroups.

● TB Recurrence/Relapse: The study identified a higher risk of TB recurrence/relapse among individuals with a history of smoking. Specifically, the risk was nearly doubled for individuals who had ever smoked (Relative Risk [RR] = 1.78) compared to those who had never smoked. Current smokers faced an even higher risk (RR = 1.95), while individuals who had quit smoking in the past still had an elevated risk (RR = 1.84). Heterogeneity in the results was attributed to differences in study quality, design, and participant characteristics.

● Mortality During Treatment: Among the 38 studies analyzed, 13 reported on mortality during TB treatment. The study found that ever-smokers had a 55% higher risk of mortality during treatment compared to non-smokers. Current smokers faced a 51% higher risk. Variability in the results was largely explained by differences in study design.

● Smokeless Tobacco (ST): Although limited evidence was available for ST use, the identified studies suggested an increased risk of poor TB treatment outcomes associated with its use compared to non-use

These findings underscore the significant impact of tobacco use on TB treatment outcomes. Smoking, in particular, was strongly associated with an elevated risk of TB recurrence/relapse and mortality during treatment. The study's authors emphasize the importance of addressing smoking and tobacco use as part of TB management to improve treatment outcomes. It highlights the need for comprehensive strategies to tackle tobacco use among individuals with TB, ultimately aiming to enhance their chances of successful treatment and recovery.

These results reinforce the importance of public health efforts to reduce tobacco use and its detrimental effects on health, especially in populations at risk for TB.

Reference:

Vidyasagaran, A. L., Readshaw, A., Boeckmann, M., Jarde, A., Siddiqui, F., Marshall, A.-M., Akram, J., Golub, J. E., Siddiqi, K., & Dogar, O. (2023). Is tobacco use associated with risk of recurrence and mortality among people with tuberculosis? A systematic review and meta-analysis. Chest. https://doi.org/10.1016/j.chest.2023.08.021