PT  - JOURNAL ARTICLE
AU  - Chi C. Leung
AU  - Wing W. Yew
AU  - Chi K. Chan
AU  - Kwok C. Chang
AU  - Wing S. Law
AU  - Shuk N. Lee
AU  - Lai B. Tai
AU  - Eric C.C. Leung
AU  - Ronald K.F. Au
AU  - Shan S. Huang
AU  - Cheuk M. Tam
TI  - Smoking adversely affects treatment response, outcome and relapse in tuberculosis
AID  - 10.1183/09031936.00114214
DP  - 2015 Mar 01
TA  - European Respiratory Journal
PG  - 738--745
VI  - 45
IP  - 3
4099  - http://erj.ersjournals.com/content/45/3/738.short
4100  - http://erj.ersjournals.com/content/45/3/738.full
SO  - Eur Respir J2015 Mar 01; 45
AB  - The impact of smoking on tuberculosis outcome was evaluated in a territory-wide treatment programme. 16 345 consecutive patients undergoing chemotherapy for active tuberculosis in government chest clinics in Hong Kong from 2001 to 2003 were followed up prospectively for 2 years for treatment outcome and subsequently tracked through the territory-wide tuberculosis notification registry for relapse until the end of 2012. Smoking was associated with more extensive lung disease, lung cavitation and positive sputum smear and culture at the baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Both categories of smokers were significantly less likely to achieve cure or treatment completion within 2 years. Overall, 16.7% of unsuccessful treatment outcomes were attributable to smoking, with the key contributor being default in current smokers and death in ex-smokers. Among successful treatment completers, there was a clear gradient (hazard ratios of 1.00, 1.33 and 1.63) of relapse risk from never-smokers to ex-smokers and current smokers, with an overall population attributable risk of 19.4% (current smokers: 12.2%; ex-smokers: 7.2%). Smoking adversely affects baseline disease severity, bacteriological response, treatment outcome and relapse in tuberculosis. Smoking cessation likely reduces relapse and secondary transmission. Smoking adversely affects treatment response in TB. Smoking cessation reduces relapse and secondary transmission. http://ow.ly/CjFZG