Tuberculosis (TB) and tobacco use are currently two formidable public health concerns and independently pose a considerable threat to global health, and India in particular. With nearly 2.6 million TB patients annually, India is the highest tuberculosis burden-country accounting for one-fourth (26 percent) of the global incidence. Every year, around a quarter of a million people die due to TB in India.
That is 2 deaths due to TB every 5 minutes. Also, with over 260 million tobacco users, India has over a quarter of the world’s tobacco consumers. Tobacco use kills nearly a million users annually in India.
TB and tobacco use are intricately linked. Almost 38 percent of tuberculosis deaths are associated with tobacco use. It is proven that exposure to tobacco smoke increases the risk of both tuberculosis infection and disease. Tobacco smokers have twice the risk of developing tuberculosis disease when compared to non-smokers. Patients with TB who smoke have twice the risk of death during tuberculosis treatment. There is substantial evidence to link smoking with tuberculosis disease and poor treatment outcomes.
Smoking damages the lungs and makes them more susceptible to TB. Tobacco use also interacts at an immunologic and cellular level to reduce antitubercular treatment efficacy. Although similar data are not available for Indian forms of oral smokeless tobacco products (gutkha, zarda), those products also contain carcinogens and are known to adversely impact the users’ immunity.
Tobacco cessation improves the respiratory tract’s ciliary function and local immunological responses, thereby improving cure rates in people with TB. This TB-tobacco connection is not known or practised by those delivering the DOTS treatment- thus missing out on an opportunistic win-win. E.g. The section for tobacco use history in the medical records of TB patients is more often than not left blank.
Proactively enabling tobacco cessation is essential for improving treatment outcomes in TB patients as well as reducing population-level TB incidence in the long run. India has set an ambitious target to achieve “END TB” goals of 80 percent reduction in incidence and 90 percent reduction in deaths by 2025, which is 5 years earlier than the stipulated timeline. India rebranded its RNTCP (Revised national TB control programme) to NTEP (National TB Elimination Programme) in 2020, to underscore this ambition. Currently, NTEP is well resourced and funded, with treatment centres spread across the country and community, and a strict protocol for administering WHO prescribed DOTS treatment. DOTS consists of a combination of key anti-tuberculosis drugs for six months under observation and adherence monitoring.
CNBC – 2021-03-24.
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