Smoking and Tuberculosis (TB)

According to the World Health Organization (WHO), the risk of prevalence of TB infection is more among current or ex-smokers than never smokers. The risk of TB is more with the duration of smoking than the number of cigarettes smoked daily.
 
The biological basis by which smoking increases the TB risk may be through a decreased immune response, mechanical disruption of cilia function, defects in macrophage immune responses, and/or CD4+ lymphopenia, thereby increasing the susceptibility to pulmonary TB.

Smoking may increase the risk of developing tuberculosis infection, show researchers in Thorax. Participants were surveyed about their smoking habits and underwent a tuberculin skin test. Of 1,309 current smokers or ex-smokers, 1,070 (82%) had a positive skin test. This was significantly higher than for never smokers.

Smoking reduces the defences on the surface of the respiratory apparatus, alters the mucociliary apparatus through cell destruction and dysfunction and reduces lysozyme activity. As a result, germs and toxic substances reach the alveolar tissue in greater numbers.

Smoking also produces alterations in both natural and acquired cell immunity, affecting macrophages and leukocytes. It induces apoptosis in both activated and non-activated macrophages, leading to the multiplication of the bacilli.
 
Smoking influences the clinical progress of TB lesions. Smokers tend to have more cavitary disease, and greater severity despite diagnostic delays similar to those among non-smokers.
 
Interventions against TB should include messages to increase public awareness on the dangers of smoking. Action against smoking and hazardous lifestyles and living conditions can help reduce the impact of TB in the community.

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