Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains one of the most significant global health challenges, causing over 10 million new cases and 1.4 million deaths annually. Despite public health interventions, TB continues to devastate TB-endemic regions such as India, which carries a substantial global TB burden. Tobacco smoking is a recognized risk factor for TB, contributing to disease susceptibility, delayed treatment outcomes, and increased mortality. This study explores the clinical, bacteriological, and radiological differences between smokers and non-smokers with pulmonary TB, along with treatment outcomes at a tertiary care hospital in Bikaner, India.

Aims and Objectives

Aim:
To compare the clinico-bacterio-radiological profiles and treatment outcomes of smokers and non-smokers with pulmonary tuberculosis.

Objectives:

1. To analyze and compare treatment outcomes in smokers versus non-smokers.
2. To study clinical, bacteriological, and radiological presentations in the two groups.

• Study Design: Prospective observational hospital-based study.
• Study Area: Department of Respiratory Medicine, S.P. Medical College, Bikaner.
• Duration: 2024–2025.
• Sample Size: 100 patients with pulmonary TB (smokers and non-smokers).
• Sampling Technique: Simple random sampling.

Inclusion Criteria:

• Adults (>18 years) with sputum smear-positive pulmonary TB.
• Patients willing to provide consent.

Exclusion Criteria:

• Drug-resistant TB, extra-pulmonary TB, or comorbidities like HIV or malignancy.
• Pregnant patients or those with a history of prior TB treatment.

Data Collection:

Participants underwent clinical evaluation, sputum analysis, and radiographic assessment. Data were recorded using pre-tested proforma.

Statistical Analysis:

Data were analyzed using MS Excel and Epi Info to determine statistical significance (P<0.05).

. Demographics

• Age: Maximum patients (46%) were aged 41–60 years, with a mean age of 50.5 ± 10.5 years.
• Gender: 67% were male.
• Address: 78% were from rural areas.
• Socioeconomic Status: 39% were in the lowest class (V).

2. Smoking Status

• 52% were non-smokers, while 16% were ex-smokers, and 32% were current smokers.
• Among smokers, 35% smoked beedis and 13% smoked cigarettes.

• Demographic Data

• All demographic characteristics, highlighting key findings such as majority age group (41-60 years), male predominance (67%), rural dominance (78%), and high prevalence of non-smokers (52%). Additionally, it shows socioeconomic distribution skewed towards lower classes (class V, 39%) and beedi as the most common smoking type among smokers (35%).

3. Clinical Presentation

• All patients presented with cough with expectoration.
• Smokers reported higher rates of breathlessness (P=0.016).

4. Bacteriological Profile

• Majority had 1+ sputum AFB grades during the intensive phase.
• Smokers showed more advanced sputum positivity compared to non-smokers (P<0.0001).

5. Radiological Profile

• Smokers had significantly more cavitation (35%) and advanced radiographic severity compared to non-smokers (P<0.05).
• Smokers were more likely to have unilateral lung involvement (53%).

6. Treatment Outcomes

• 73% were cured, 24% completed treatment, and 3% defaulted.
• Smokers had worse outcomes and higher rates of treatment failure (P=0.01).

• Table of Clinical and Diagnostic Characteristics of Study Population

• This table provides a consolidated view of the clinical presentations, diagnostic findings, radiographic evaluations, and treatment outcomes of the study population. The majority of patients had moderate severity on radiography, no cavitation, and achieved a cure by the end of treatment.

This study highlights significant differences in the clinical, bacteriological, and radiological profiles of smokers versus non-smokers with TB. Smokers demonstrated:

1. Delayed Sputum Conversion: Smoking impairs immune responses, leading to prolonged sputum positivity.
2. More Severe Radiological Findings: Higher cavitation rates and advanced lung damage suggest that smoking exacerbates TB pathophysiology.
3. Worse Treatment Outcomes: Smokers had a higher risk of treatment failure and relapse, aligning with global evidence that smoking compromises TB management.

The findings are consistent with prior studies (e.g., Agrawal et al., DeeptiRathee et al.), emphasizing the role of smoking cessation in improving TB outcomes.

Smoking significantly impacts the clinical course and outcomes of pulmonary TB. Smokers experience:

• More severe symptoms and radiological findings.
• Delayed sputum conversion and treatment failure.

Addressing smoking as part of TB management is crucial to achieving global TB control goals.

Recommendations

1. Smoking Cessation Programs: Integrate cessation strategies into TB management protocols.
2. Larger Multi-Center Studies: To strengthen causal evidence between smoking and TB outcomes.
3. Community-Based Interventions: Focus on rural and socioeconomically disadvantaged populations to reduce TB incidence.

Limitations

1. Self-reported smoking data may be prone to underreporting.
2. Limited sample size and single-center study.

1. Exclusion of comorbidities like HIV may limit generalizability

1. World Health Organization. Global Tuberculosis Report 2023. Geneva: WHO; 2023. Available from: https://www.who.int/tb/publications/global_report/en/
2. Agrawal A, Kolappan C, Rathee D, et al. Impact of smoking on tuberculosis treatment outcomes: An observational study. Indian J Tuberc. 2011;58(4):174-180.
3. S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention (CDC); 2014.
4. Rathee D, Mahishale V, Alavi-Naini R, et al. Association of smoking with tuberculosis severity and outcomes: Evidence from observational studies. Int J Respir Med. 2016;3(2):78-85.
5. Kolappan C, Gopi PG. Tobacco smoking and pulmonary tuberculosis. Thorax. 2002;57(11):964-966. doi:10.1136/thorax.57.11.964
6. Mahishale V, Avuthu S, Patil B, et al. Effect of smoking on treatment outcomes of patients with pulmonary tuberculosis in India. J Infect Public Health. 2015;8(6):543-550. doi:10.1016/j.jiph.2015.04.001
7. Rathee D, Gopi PG. Smoking as a predictor of delayed sputum conversion in pulmonary tuberculosis: A case-control study. Indian J Chest Dis Allied Sci. 2016;58(2):98-102.
8. Alavi-Naini R, Moghtaderi A, Metanat M, et al. Association between tuberculosis and smoking. Int J RespirPulm Med. 2015;3:2-8.
9. Global Burden of Disease 2020. Tobacco smoking prevalence and attributable mortality. Institute for Health Metrics and Evaluation (IHME); 2021. Available from: https://www.healthdata.org
10. Kolappan C, Gopi PG. Tobacco smoking and pulmonary tuberculosis: A case-control study. Thorax. 2002;57:964-966. doi:10.1136/thorax.57.11.964
11. Semb G, Al-Juboori AN, et al. Smoking and delayed culture conversion in tuberculosis treatment. Public Health Rev. 2015;34(3):105-110.
12. World Health Organization. WHO Framework for Effective Tobacco Control in Tuberculosis. Geneva: WHO; 2015. Available from: https://www.who.int/tobacco
13. Rathee D, Alavi-Naini R. Pulmonary sequelae of tuberculosis in smokers: A systematic review. J Pulmonol. 2018;6(4):215-220.
14. Sinha A, Ghosh P, et al. Tobacco and tuberculosis in India: An overview. Indian J Public Health. 2017;61:124-130. doi:10.4103/ijph.IJPH_186_17
15. WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003. Available from: https://fctc.who.int
16. Global Initiative for Tuberculosis and Tobacco Control. Integrated approaches for TB and tobacco management. Geneva: WHO; 2020. Available from: https://www.who.int/globaltb_tobacco_report.