Integrating Management of TB and Tobacco Control

Large cohort, case-control, and cross-sectional studies carried out all over the world reveal that when TB and smoking rates are high in a population smoking is related to: increased TB sub-clinical infection rates, excess TB mortality rates, and increase TB disease incidence rates. However, the morbidity and mortality of infectious diseases due to smoking are not widely recognized by healthcare professionals and researchers. Reducing Deaths from TB and Tobacco Together is a cross-sectional multi-country study conducted among 1500 TB patients in China, India, Iran, Mexico, and Russia. The aim of this project was to develop an evidence-based approach to the management of TB patients who smoke and mainstream it into major international and national guidelines and actions. The findings from this study indicate that tobacco use among male TB patients is extremely high ranging from 50% in Iran to 91% in Russia. Among females, prevalence of smoking is 15%, with extremely high prevalence rate of 64% among Russian females. Further, 40% of the total sample reported being exposed to second hand smoke. Despite the high prevalence of tobacco consumption, 78% of smokers had not received tobacco cessation counseling during the last year. Conversely, those who had received cessation advice were three times more likely to quit compared to their counterparts. These findings suggest that there is a great need for sustained international efforts and clinical guidelines to simultaneously address two major assaults on the lung.

With a marginal extra effort health care professionals can play a great role in reducing the adverse effects of tobacco use among TB patients. Importantly, since both TB patients and smokers are generally among the low income groups with poor access to health services, integration of TB and tobacco control provides an opportunity for increasing coverage and effectiveness of TB program. The scientific evidence, clearly convey the necessity of a formal policy process that aims to bridge the divide between those involved in TB treatment and those involved in tobacco control.