Tobacco Exposure and Tuberculosis Outcomes
Summary
Tobacco exposure remains a critical modifiable factor influencing the risk, progression and treatment outcomes of tuberculosis (TB) on a global scale. Cigarette smoke and second-hand tobacco smoke compromise pulmonary defences and systemic immunity, increasing susceptibility to infection with Mycobacterium tuberculosis and promoting the transition from latent infection to active disease. Smoking alters macrophage function, impairs mucociliary clearance and disrupts cytokine networks, culminating in higher bacillary loads and more severe lung pathology. In patients receiving anti-TB therapy, tobacco use is linked to delayed sputum conversion, elevated rates of treatment failure, default and relapse, as well as increased mortality. Passive smoking in high-burden settings further exacerbates paediatric and adult TB incidence. Emerging evidence underscores the benefits of integrating smoking cessation into TB programmes, offering an impactful strategy to enhance cure rates, reduce recurrence and attenuate long-term pulmonary sequelae.
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Tobacco Exposure and Tuberculosis Outcomes publication trend
The graph below shows the total number of articles in tobacco exposure and tuberculosis outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Latent tuberculosis infection (LTBI): A state in which individuals harbour Mycobacterium tuberculosis without clinical symptoms, detectable by immune-based assays.
Recurrence: The re-emergence of active TB disease in a patient following completion of a successful treatment course, reflecting relapse or reinfection.
T regulatory cells (Tregs): A subset of lymphocytes that downregulate immune responses and, when modulated by cigarette smoke, can impair host protective immunity against pathogens including M. tuberculosis.
Hazard ratio (HR): A statistical measure in cohort studies comparing the instantaneous risk of an event (such as death or recurrence) between two groups over time.
References
- Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB? A Systematic Review and Meta-Analysis. CHEST Journal (2023).
- Ex vivo and in vivo evidence that cigarette smoke-exposed T regulatory cells impair host immunity against Mycobacterium tuberculosis. Frontiers in Cellular and Infection Microbiology (2023).
- Smoking cessation to prevent death and tuberculosis recurrence after treatment: A prospective cohort study with a seven-year follow-up in China.. Journal of Global Health (2024).
- Effect of smoking on tuberculosis treatment outcomes: A systematic review and meta-analysis. PLOS ONE (2020).
- Exposure to Second-Hand Smoke and the Risk of Tuberculosis in Children and Adults: A Systematic Review and Meta-Analysis of 18 Observational Studies. PLOS Medicine (2015).
- The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes. Substance Abuse Treatment, Prevention, and Policy (2011).
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