The 13th World Conference on Tobacco OR Health

Objectives: To assess the strength of evidence for an association between exposure to tobacco smoke and various manifestations and outcomes of tuberculosis.

Methods: PubMed, the Union database and Google Scholar were searched. Forty-two articles in English containing 49 studies were included for data extraction. A quality score was attributed to each article according to criteria established by a steering committee. Levels of evidence are ranked according to the following: Strong evidence is provided by generally consistent findings in multiple high-quality cohort and case-control studies; Moderate evidence is provided by generally consistent findings in (a) One high-quality cohort and two or more high-quality case control studies, or (b) Three or more high-quality case control studies; Limited evidence is provided by generally consistent findings in (a) A single cohort study or (b) One or two case-control studies or (c) Multiple cross-sectional studies; Not enough evidence is provided when the above conditions are not met; Conflicting evidence is provided when less than 75% of the studies report consistent findings.

Results: The evidence was rated as strong for an association between exposure to tobacco smoke and tuberculosis disease, moderate for the association between tobacco use and recurrent tuberculosis disease, limited for the association between exposure to tobacco smoke and tuberculous infection and between tobacco use and tuberculosis mortality. There was not enough evidence to support an association of tobacco use and patient delay, default, slower smear conversion, greater severity of disease or drug-resistant tuberculosis.