Article

Tobacco and tuberculosis: A qualitative systematic review and meta-analysis

The International Union Against Tuberculosis and Lung Disease, Paris, France.
The International Journal of Tuberculosis and Lung Disease (Impact Factor: 2.76). 11/2007; 11(10):1049-61.
Source: PubMed

ABSTRACT To assess the strength of evidence in published articles for an association between smoking and passive exposure to tobacco smoke and various manifestations and outcomes of tuberculosis (TB). Clinicians and public health workers working to fight TB may not see a role for themselves in tobacco control because the association between tobacco and TB has not been widely accepted. A qualitative review and meta-analysis was therefore undertaken.
Reference lists, PubMed, the database of the International Union Against Tuberculosis and Lung Disease and Google Scholar were searched for a final inclusion of 42 articles in English containing 53 outcomes for data extraction. A quality score was attributed to each study to classify the strength of evidence according to each TB outcome. A meta-analysis was then performed on results from included studies.
Despite the limitations in the data available, the evidence was rated as strong for an association between smoking and TB disease, moderate for the association between second-hand smoke exposure and TB disease and between smoking and retreatment TB disease, and limited for the association between smoking and tuberculous infection and between smoking and TB mortality. There was insufficient evidence to support an association of smoking and delay, default, slower smear conversion, greater severity of disease or drug-resistant TB or of second-hand tobacco smoke exposure and infection.
The association between smoking and TB disease appears to be causal. Smoking can have an important impact on many aspects of TB. Clinicians can confidently advise patients that quitting smoking and avoiding exposure to others' tobacco smoke are important measures in TB control.

Download full-text

Full-text

Available from: Kristen Hassmiller Lich, Jul 02, 2014
0 Followers
 · 
95 Views
  • Source
    • "In large European metropolitan areas, for example, in London [14], in Rotterdam [4], in Marseilles [15], and in the Warminsko-Mazurskie Province of Poland [16], a high prevalence of Tb was still observed in homeless people. Immigration, under-nutrition [17], smoking [18], diabetes [19], and alcohol misuse [20] "
    [Show abstract] [Hide abstract]
    ABSTRACT: The authors show the results of an integrated model for risk management of tuberculosis in a sample of sheltered homeless in Rome. Tuberculin skin test (TST) was used for evaluating the prevalence of latent infection (LTBI). In TST positives, expectorate was collected and chest X-ray was achieved. Multiple logistic regression analysis was performed to investigate determinants of infection. Out of 288 recruited subjects, 259 returned for the TST reading; 45.56% were positive and referred to a specialized center; 70 accessed the health facility and completed the clinical pathway. The risk factors associated to LTBI were male gender (OR = 3.72), age over 60 years (OR = 3.59), immigrant status (OR = 3.73), and obesity (OR = 2.19). This approach, based on an integrated social network, guarantees high adherence to screening (89.93%), allowing patients testing positive for latent tuberculosis infection to be diagnosed and rapidly referred to a specialized center.
    The Scientific World Journal 02/2012; 2012:396302. DOI:10.1100/2012/396302 · 1.73 Impact Factor
  • Source
    • "On the other hand, several factors arising from a general decline in social conditions and living standards can also increase individual susceptibility to infection and progression to active disease. There is evidence to link unemployment and financial insecurity with risk of pulmonary TB in Russia (Coker et al. 2005), while studies elsewhere have highlighted the role of alcoholism (Lönnroth et al. 2008), malnutrition (Cegielski & McMurray 2004), crowded housing (Canadian Tuberculosis Committee 2007) and smoking (Lin et al. 2007; Slama et al. 2007). In the wider context of health, hazardous alcohol consumption (Leon et al. 2007) and poor nutrition (McKee & Shkolnikov 2001) have also been linked to adverse health outcomes in Russia and other countries in Eastern Europe. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The ongoing global financial crisis, which began in 2007, has drawn attention to the effect of declining economic conditions on public health. A quantitative analysis of previous events can offer insights into the potential health effects of economic decline. In the early 1990s, widespread recession across Central and Eastern Europe accompanied the collapse of the Soviet Union. At the same time, despite previously falling tuberculosis (TB) incidence in most countries, there was an upsurge of TB cases and deaths throughout the region. Here, we study the quantitative relationship between the lost economic productivity and excess TB cases and mortality. We use the data of the World Health Organization for TB notifications and deaths from 1980 to 2006, and World Bank data for gross domestic product. Comparing 15 countries for which sufficient data exist, we find strong linear associations between the lost economic productivity over the period of recession for each country and excess numbers of TB cases (r(2) = 0.94, p < 0.001) and deaths (r(2) = 0.94, p < 0.001) over the same period. If TB epidemiology and control are linked to economies in 2009 as they were in 1991 then the Baltic states, particularly Latvia, are now vulnerable to another upturn in TB cases and deaths. These projections are in accordance with emerging data on drug consumption, which indicate that these countries have undergone the greatest reductions since the beginning of 2008. We recommend close surveillance and monitoring during the current recession, especially in the Baltic states.
    Journal of The Royal Society Interface 11/2010; 7(52):1559-69. DOI:10.1098/rsif.2010.0072 · 3.86 Impact Factor
  • Source
    • "Packyears of smoking (> 8 pack-years) showed an association with TB (p = 0.06), which did not change appreciably after adjustment. Smoking is now an established risk factor for TB (Bates et al. 2007; Chiang et al. 2007; Leung et al. 2004; Slama et al. 2007; Yu et al. 1988). The very elevated relative risk estimate for "
    [Show abstract] [Hide abstract]
    ABSTRACT: In Nepal, tuberculosis (TB) is a major problem. Worldwide, six previous epidemiologic studies have investigated whether indoor cooking with biomass fuel such as wood or agricultural wastes is associated with TB with inconsistent results. Using detailed information on potential confounders, we investigated the associations between TB and the use of biomass and kerosene fuels.Methods: A hospital-based case-control study was conducted in Pokhara, Nepal. Cases (n = 125) were women, 20-65 years old, with a confirmed diagnosis of TB. Age-matched controls (n = 250) were female patients without TB. Detailed exposure histories were collected with a standardized questionnaire. Compared with using a clean-burning fuel stove (liquefied petroleum gas, biogas), the adjusted odds ratio (OR) for using a biomass-fuel stove was 1.21 [95% confidence interval (CI), 0.48-3.05], whereas use of a kerosene-fuel stove had an OR of 3.36 (95% CI, 1.01-11.22). The OR for use of biomass fuel for heating was 3.45 (95% CI, 1.44-8.27) and for use of kerosene lamps for lighting was 9.43 (95% CI, 1.45-61.32). This study provides evidence that the use of indoor biomass fuel, particularly as a source of heating, is associated with TB in women. It also provides the first evidence that using kerosene stoves and wick lamps is associated with TB. These associations require confirmation in other studies. If using kerosene lamps is a risk factor for TB, it would provide strong justification for promoting clean lighting sources, such as solar lamps.
    Environmental Health Perspectives 04/2010; 118(4):558-64. DOI:10.1289/ehp.0901032 · 7.03 Impact Factor
Show more