Controlling TB: Combating tobacco and tuberculosis together

By Dr Vikas Maurya,

Tuberculosis is a major cause of ill health, the leading cause of death from a single infectious agent in the developing world. Tobacco, particularly smoking is recognized by the medical community as a major public health hazard. It affects all part and organs of the body apart from the respiratory system which is predominantly affected.

This harmful socio-economic factor was less thought of as a contributor to the morbidity and mortality of tuberculosis but since the publication of first ever review article on association between smoking tobacco and tuberculosis in 2002 (Maurya V et al) in International Journal of Tuberculosis and Lung diseases, many such studies and articles have published in last two decades showing a strong association between smoking tobacco and tuberculosis infection and disease. Not only pulmonary tuberculosis but extrapulmonary tuberculosis has also been linked to smoking tobacco. Similarly, studies have found increase incidence of positive tuberculin skin test in smokers. Even passive smoking has been linked to increased incidence of pulmonary tuberculosis.

As per WHO, smoking substantially increases the risk of tuberculosis and death from tuberculosis. It increases the risk of tuberculosis disease by more than two and a half time. It’s a risk factor for tuberculosis, independent of alcohol use and other socioeconomic risk factors. More than 20% of global TB incidence may be attributable to smoking. And controlling the tobacco epidemic will help control the TB epidemic. In this respect, one can have a look at the ‘End Tobacco to Eliminate TB: Communication Toolkit’, launched by public health organisation Vital Strategies in collaboration with the National Tuberculosis Elimination Programme (NTEP) of Ministry of Health and Family Welfare and The International Union Against Tuberculosis and Lung Disease (The Union) – allowing for the coordination of national programmes of both tuberculosis and tobacco control together. Further, the toolkit provides pre-tested public service announcement, ‘Cough’ in 17 national and regional languages. ‘Cough’ is the first-ever campaign highlighting the link between TB and tobacco use and was rated as one of the highest in terms of potential effectiveness for TB prevention and treatment.

The mechanism behind association between smoking and pulmonary tuberculosis seems to be biological. Smoking tobacco causes changes in the structural and functional changes in the respiratory system and also affects the alveolar immune cells. The occurrence of tuberculosis is thought to be linked to altered immune response, decrease in immune cells and/or other mechanisms. All of these factors, in combination, may contribute to increased susceptibility of an individual to tuberculosis infection and occurrence of the disease.

It is therefore recommended to combat tobacco and tuberculosis together which will help in decreasing tuberculosis incidence and mortality and adopt following principles which are widely accepted and developed (WHO). These are:

To control tobacco consumption all over the world, including those areas where people are at risk of tuberculosis infection.

To cross train tuberculosis and tobacco control health workers

To register tuberculosis patients’ tobacco, use and offer them counselling and treatment.

To promote and enforce smoke-free policies, particularly where tuberculosis services are delivered.

To integrate brief tobacco control interventions into tuberculosis control programme activities

To promote smoking cessation practices

(The author is Director and Head, Department of Pulmonology & Sleep Disorders, Fortis Hospital, Shalimar Bagh, Delhi. The article is for informational purposes only. Please consult experts and medical professionals before starting any therapy or medication. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)