The association between smoking and tuberculosis.

OBJECTIVE To review epidemiological evidence on the association between smoking and tuberculosis. METHODS Reviewed articles were identified by searching Pubmed for the terms "smoking" or "tobacco" and "tuberculosis". Additional articles were obtained from the bibliographies of identified papers. RESULTS Thirty-four studies were reviewed: five investigate the association between smoking and mortality from tuberculosis, 13 investigate the association between smoking and development of tuberculosis, eight investigate the association between smoking and infection with Mycobacterium tuberculosis, and nine estimate the impact of smoking on characteristics of tuberculosis and disease outcomes. CONCLUSIONS Taken together, evidence suggests that smoking (both current and former) is associated with: risk of being infected with Mycobacterium tuberculosis, risk of developing tuberculosis, development of more severe forms of tuberculosis, and risk of dying of tuberculosis. In many cases, there is a strong dose-response relationship -both in terms of quantity and duration of smoking. These relationships are not explained away by controlling for potentially confounding variables such as age, gender, alcohol consumption, and HIV status.