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: 2.32). 11/2007; 11(10):1049-61.
Source: PubMed


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.

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Available from: Kristen Hassmiller Lich, Jul 02, 2014
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    • "These two global epidemics amplify each other's negative impact on population health. Tobacco smoking increases the risk of acquiring TB infection, developing disease and worsening outcomes, including death, treatment failure and relapse (Bates et al., 2007; Lin, Ezzati, & Murray, 2007; Siddiqi & Lee, 2009; Slama et al., 2007). In many low-and-middle income countries (LMICs), where TB burden is high, Address for correspondence: Omara Dogar, MBBS; MPH (Epi), Research Fellow, Department of Health Sciences, University of York Room 105, ARRC, Heslington YO10 5DD, York, UK. "
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    ABSTRACT: Offering tobacco cessation interventions to TB patients is highly desirable due to the interaction between TB and tobacco use and the potential benefits of quitting. However, implementing such interventions in TB programmes remains a challenge and an under-researched area. Using two initiatives to implement tobacco cessation within TB programmes in Nepal and Pakistan as case studies, we describe these challenges and highlight lessons learnt in the process. Methods: We first conducted a documentary review of all published and unpublished reports of the two initiatives including relevant qualitative and quantitative data and its’ analyses. We then analysed this information using the Consolidated Framework for Implementation Research (CFIR) under the five domains of implementation: intervention characteristics, outer settings, inner settings, participant characteristics and the process of implementation. Findings: We faced a number of challenges in implementing tobacco cessation within TB programmes both in Nepal and in Pakistan. These included: doubts about the contextual relevance of the intervention, environments conducive to smoking and political inertia for a cultural shift, service providers’ workload, priorities, and their motivation and capacity to deliver tobacco cessation, and inadequate training and support during implementation. We learned that by adapting intervention to the local context, securing mandate from higher authorities, aligning tasks to service providers’ roles and receptivity, building capacity through adequate training and providing support, monitoring and feedback during implementation can help in integrating tobacco cessation within TB programmes. Conclusions: Lessons from existing studies can help TB programmes in implementing tobacco cessation interventions and enable greater integration and sustainability of cessation services within routine TB care.
    Full-text · Article · Feb 2016 · The Journal of Smoking Cessation
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    • "The association of smoking with TB infection and disease have been corroborated by other meta-analyses [20] [21]. In addition to tobacco smoke, the association of indoor air pollution, caused by smoke from the burning of biomass fuel, with COPD has been well documented [18] [23]. "
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is emerging as the third largest cause of human mortality worldwide after heart disease and stroke. There is growing evidence of a co-morbidity between COPD and tuberculosis (TB), the leading cause of death globally due to respiratory infection. Thus, the increase in the burden of COPD over the coming decades, as predicted by the World Health Organisation, is of concern with respect to the control of TB. A better understanding of the interactions between these two diseases is essential for the design of complementary preventive and control strategies. In this review, some of the known risk factors that are common to both diseases are discussed. Furthermore, we examine how impairment of the innate immune system, and corticosteroid therapy, in COPD patients may increase the risk of TB manifestation. Conversely, we review how TB lung pathology may heighten susceptibility to subsequent development of COPD, even after completion of effective TB treatment. Growing evidence appears to point towards a bi-directional relationship between these two lung diseases where each may act as an independent risk factor for the other. This has important implications for the respective long-term management of TB and COPD.
    Full-text · Article · Sep 2015 · Tuberculosis
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    • "There is an inter-relationship between respiratory disease and tobacco that can be seen both in morbidity and mortality. For TB, this association is found at every stage from initial infection (Bates et al., 2007; Yach, 2001) conversion (Slama et al., 2007) and development of disease (Bates et al., 2007) to outcomes; as smokers are less likely to adhere to TB treatment, more likely to relapse after completing treatment or need re-treatment (Chiang et al., 2007) and have a higher chance of dying due to their tobacco use (Slama et al., 2007). In South East Asia, deaths attributed to tobacco accounted for 8% of all TB deaths (WHO, 2012b). "
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    ABSTRACT: Smoking cessation services are rarely found within health services in low income countries. Given the interactions between Tuberculosis (TB) and tobacco, including cessation support within TB programs offers a promising cost-effective solution. We conducted secondary analysis of data from a cluster randomized controlled trial of smoking cessation in health centers in Pakistan to identify predictors of continuous and short-term abstinence in smokers suspected of TB using cigarettes or hookah. Predictor variables of those continuously abstinent at 5 and 25 weeks post quit-date (continuous abstinence) and those abstinent only at 5 weeks (short-term abstinence) were compared with those who continued smoking and with each other. Self-reported abstinence at both time points was confirmed biochemically. Data obtained from 1955 trial participants were analyzed. The factors that predicted continued smoking when compared to continuous abstinence were: being older RR 0.97 (0.95 to 0.98), smoking higher quantities of tobacco RR 0.975 (0.97 to 0.98) and sharing a workplace with other smokers RR 0.88 (0.77 to 0.99). Those with a confirmed TB diagnosis were more likely to remain continuously abstinent than those without RR 1.27 (1.10-1.47). Those diagnosed with TB are more likely to be abstinent than those diagnosed with other respiratory conditions. Beyond this, predictors of continued smoking in Pakistan are similar to those in high income contexts. Taking advantage of the 'teachable moment' that a TB diagnosis provides is an efficient means for resource-poor TB programs in low income settings to increase tobacco cessation and improve health outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Aug 2015 · Drug and alcohol dependence
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