The link between poor tuberculosis treatment outcomes and tobacco use is well documented. However, for important outcomes such as recurrence or mortality during treatment and for associations with smokeless tobacco, the findings have not yet been systematically summarized. An international research group has taken on this task.
Tobacco consumption and tuberculosis (TB) contribute significantly to the global burden of disease, both individually and in their mutual effects. Surprisingly, tobacco consumption among people with tuberculosis is estimated to be higher (around 8%) than in the general population. Assuming that the relative prevalence of tobacco use and tuberculosis remains stable, it is estimated that by 2050 more than 40 million TB-related deaths will be attributable to tobacco use. In addition, smokeless tobacco (ST) is consumed by more than 300 million people worldwide, with some studies indicating a negative association with tuberculosis, the scientists write [1].
Their review and meta-analysis showed that tobacco use significantly increases the risk of tuberculosis recurrence or relapse and the mortality rate during the treatment of TB patients. For their analysis, they used 91 cohort studies, 25 case-control studies and nine cross-sectional studies with sample sizes ranging from 52 to more than 1 million participants. This systematic review identified a substantial number of epidemiologic studies on the association between tobacco use and TB treatment outcomes, which clearly showed an increased risk associated with tobacco use.
No meta-analysis conducted to date
Since 2007, the association between tobacco use and relapse or recurrence of TB has not been systematically analyzed, and no meta-analysis has been conducted, although the need has been pointed out, according to Dr. Vidyasagaran et al. In terms of mortality, previous reviews have mainly identified estimates of tuberculosis mortality that considered the relationship between tobacco use and tuberculosis incidence rather than treatment outcomes. The authors focused on mortality during treatment, as this provides a more objective indication of mortality as an outcome of treatment.
The study also revealed an increased risk of treatment errors, failure, lack of adherence and delayed sputum conversion. The severity of the disease and the development of drug-resistant tuberculosis (DRTB) were two other outcomes that were included. According to the authors, the relationship between ST and TB treatment outcomes has not yet been studied. Eight studies were found that looked at treatment failure, tuberculosis mortality and treatment non-adherence, but only six studies reported on ST risk. However, all but one of the studies reported an increased risk associated with the use of ST.
In summary, the results indicate an increased risk of tuberculosis recurrence and increased mortality during treatment associated with smoking compared to never smokers or non-tobacco users. Tobacco use is also a clear risk factor for other unfavorable TB treatment outcomes, as documented in previous reviews. Although the evidence on ST is limited, it suggests that people should be aware of the risks associated with tobacco use.
A large proportion of people with tuberculosis who use tobacco are willing to stop smoking, and those who have stopped smoking have better treatment outcomes (91% vs. 80%; p<0.001) and lower relapse rates (6% vs. 14%; p<0.001). The results of the review provide additional evidence of the value of investing in these policies and practices to reduce the global burden of tuberculosis and tobacco-related diseases.
| Take-Home-Messages |
| A higher risk of TB recurrence or relapse was identified, |
| – if those affected had ever used tobacco compared to people who had never used tobacco (risk ratio [RR] 1.78; 95% CI 1.31-2.43; I2 85%), |
| – if they currently used tobacco compared to people who did not use tobacco (RR 1.95; 95% CI 1.59-2.40; I2 72%) and |
| – if they had previously used tobacco compared to people who had never used tobacco (RR 1.84; 95% CI 1.21-2.80; I2 4%). |
| In addition, previous tobacco use (RR 1.55; 95% CI 1.32-1.81; I2 0%) and current tobacco use (RR 1.51; 95% CI 1.09-2.10; I2 87%) significantly increased the probability of death in people with tuberculosis compared to never or no tobacco use. |
| Evidence on smokeless tobacco was limited, but some studies suggested an increased risk of poor outcomes associated with smokeless tobacco use compared with no use. |
Literature:
- Vidyasagaran AL, Readshaw A, Boeckmann M, et al.: Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB? Chest 2024; 165: 22–47; doi: 10.1016/j.chest.2023.08.021.
InFo PNEUMOLOGIE & ALLERGOLOGIE 2024; 6(1): 27
HAUSARZT PRAXIS 2024; 19(4): 53
