Comparative study of clinico-bacterio-radiological profile and treatment outcome of smokers and nonsmokers suffering from pulmonary tuberculosis.
BACKGROUND
Tuberculosis (TB) is one of the leading causes of death and disease worldwide. Tobacco smoking has been linked as a risk factor for TB. This study was aimed to affirm the strength of association between smoking and pulmonary TB.


METHODS
Pulmonary TB patients aged between 18 and 65 years were enrolled and followed-up until treatment completion. Two consecutive sputum smears were examined from each patient for the presence of acid-fast bacilli (AFB) using Ziehl-Neelsen technique. Radiological severity of disease was assessed using guidelines of National TB Association of USA. Sputum smears for AFB were graded for positivity as per WHO Revised National TB Control Programme criteria. Response was determined in terms of sputum conversion at the end of intensive phase and final treatment outcomes.


RESULTS
Sputum smear grading of 3+ increased from 12.5% to 68.18% and 66.66% as smoking index increased from <100 to 100-299 and >300 (P < 0.05). In nonsmokers, 79.2% patients had minimal disease while only 4.2% had advanced disease as compared to smokers where 52.4% had moderate disease, 26.2% advanced disease, and 21.4% minimal disease (P < 0.01). Smokers had significantly lower treatment success rate (69%) as against nonsmokers and former smokers (93.8% and 90.9%, respectively, P = 0.001) owing to a higher default rate among smokers (28.5%) than nonsmokers (6.3%) and former smokers (9.1%).


CONCLUSIONS
Smokers during initial presentation, as well as at end of the treatment demonstrate more radiological findings, cavitary disease, and worse sputum AFB smear grading. Smokers also have a poorer treatment success rate largely due to high percentage of default rate thus suggesting noncompliance as a main confounder to treatment success. Focus needs to be made to reduce defaulters which are more common among smokers.
Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
Deepti
D
Rathee
Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
Piyush
P
Arora
Department of Respiratory Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India.
Manoj
M
Meena
Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
Rohit
R
Sarin
Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
Pitambar
P
Chakraborty
Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
Anand
A
Jaiswal
Department of Respiratory Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India.
Mukesh
M
Goyal
Smoking; smoking and tuberculosis; smoking cessation; tuberculosis