Association of Tuberculosis with smoking and indoor air pollution

A new study from Hsien-Ho Lin and colleagues at Harvard School of Public Health reviewed the published evidence for an association between tobacco smoking, passive smoking, and indoor air pollution from fuels such as wood and charcoal and the risk of infection, disease, and death from TB.

Among hundreds of reports from electronic databases, the authors reviewed 33 eligible papers on tobacco smoking and TB, five papers on passive smoking and TB, and five on indoor air pollution and TB.

The researchers separately assessed different aspects of TB risk: TB infection as measured by a positive tuberculin skin test, TB disease, and mortality from TB. They found an approximately 2-fold increase in risk of TB infection among smokers as compared with nonsmokers.

The great majority of studies evaluating the link between active smoking and TB disease or TB mortality also showed an association, but these data could not be combined together because of wide potential differences between the studies. In addition, there was some association of TB with passive smoking, and also with indoor air pollution, though the evidence for these associations was more limited, and will need to be confirmed by further work.

The authors conclude that “TB control programs might benefit from a focus on interventions aimed at reducing tobacco and indoor air pollution exposures, especially among those at high risk for exposure to TB”.

Citation: Lin H, Ezzati M, Murray M (2007) Tobacco smoke, indoor air pollution and tuberculosis: A systematic review and meta-analysis. PLoS Med 4(1): e20.