Is tobacco use weakening India's effort to eliminate tuberculosis?

According to the Global Adult Tobacco Survey India, 2016-17, close to 267 million adults (15 years and above) in India (29% of all adults) consume tobacco. India also has a significant burden of tuberculosis (TB), with 195 incident cases per 100,000 population.

Over a decade ago, we argued in an article, “Why 'STOP TB' is incomplete without 'QUIT SMOKING". This still holds true. It is no coincidence that a country that has the highest number of patients with TB is also the second highest consumer of tobacco. Those who smoke are twice as likely to get TB, and over three times as likely to die of the disease. Recent studies suggest that smoking also leads to poor treatment outcomes and a higher risk of relapse.

Smokeless tobacco (SLT) isn’t innocuous; several studies have reported a higher prevalence of SLT use among those diagnosed with TB when compared to the general population. Damage to the lining of the mouth and a chronic inflammatory state caused by SLT impair the body’s defences against TB bacteria.

Nicotine and nitrosamines in SLT have been shown, in animal models, to impair cellular immunity (such as macrophage function), increasing susceptibility to infection and disease. Spitting behaviors associated with SLT also facilitate the spread of TB from those with the disease.

Identifying consumers of tobacco and helping them quit is an opportunity to screen for asymptomatic (subclinical) TB. Conversely, helping tobacco consumers with TB quit improves their chances of cure and lowers their future risk of cancer, COPD (2nd leading cause of death in India), cardiovascular disease, and a relapse of TB.

India’s efforts to eliminate TB have moved from focusing solely on treatment to diagnosing the disease, and even more ambitiously, preventing the development of the disease.

In this framework, tobacco use cannot be ignored. We need to move beyond the shocking images displayed in advertisements to offering psychosocial, behavioural and pharmacologic support to those who wish to quit tobacco. The pillars of eradicating TB are arresting transmission, prevention of disease, early diagnosis and prompt and effective treatment. Policies directed towards tobacco cessation are likely to play an important role in all four of these elements. They must not be ignored.

Dr Lancelot Pinto is a Consultant Pulmonologist and Epidemiologist at PD Hinduja Hospital, Mumbai

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.

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