La tunisie Medicale - 2021 ; Vol 99 ( n°06 ) : 638-643
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Inroduction : Smoking and tuberculosis are two major public health issues worldwide, particularly in emerging countries. Currently, the relationship between these two scourges is well established.
Aim: Describe the clinical, radiological and progressive features of common pulmonary tuberculosis in smokers.

Methods : Comparative study, carried out at the Pneumology department of the Hédi Chaker in Sfax, Tunisia, including 120 patients hospitalized for common pulmonary tuberculosis  from January 2014 to December 2016 and who completed their follow-ups for a minimum period of 2 years . The patients were divided into 2 groups: Group1 (G1) consisting of 60 smoking patients and Group 2 (G2) consisting of 60 non-smoking patients. To assess the severity of radiological lesions, we used the International Labour Organization classification for simple pneumoconiosis and the Brouet classification.
Results: The mean age of the patients was comparable in the two groups with a predominance of male for G1 (91%) and female for G2 (70%). The smokers consulted later (113 days versus 60 days (p=0.023). Dyspnea, hemoptysis and chest pain were significantly more frequent in the smokers. The radiological lesions were more serious in smoking group. Bilateral lesions were more observed in smokers (58% vs 25% p = 0.004). A positive association was noted between the extent of radiological lesions, stage 3 and 4 according to the Brouet classification, and smoking status (p <0.001). Similarly for the International Labour Organization classification for simple pneumoconiosis , the radiological lesions were more severe (scores 6 - 15) in the smokers (p <0.001).Smoking was associated with poor adherence (p <0.008), prolonged anti-tuberculosis treatment (p <0.001), delayed RBK negativation in sputum (p <0.001), and more frequent reactivation of tuberculosis (p=0.001). After the diagnosis of CPT, 83% of patients continued to smoke at the same rate and only 7% of patients had quit smoking.
Conclusion Smoking worsens CPT by making the clinical picture noisier, radiological lesions more aggressive, negativation of BK in sputum later, and reactivation of CPT more frequent.

Key - Words
  1. 1. Rathee D, Arora P, Meena M, Sarin R, Chakraborty P, Jaiswal A, et al. Comparative study of clinico-bacterio-radiological profile and treatment outcome of smokers and nonsmokers suffering from pulmonary tuberculosis. Lung India. 2016;33(5):507–11. 2. OMS. Tuberculose et tabac. Organ Mond la santé. 2009; 3. Davies PDO, Yew WW, Ganguly D, Davidow AL, Reichman LB, Dheda K, et al. Smoking and tuberculosis : the epidemiological association and immunopathogenesis. Trans R Soc Trop Med Hyg. 2006;(100):291–8. 4. Kolappan C, Gopi PG. Tobacco smoking and pulmonary tuberculosis. Thorax. 2002;28(57):964–6. 5. Altet-Gómez MN, Alcaide J, Godoy P, Romero MA, Hernández Del Rey I. Clinical and epidemiological aspects of smoking and tuberculosis: A study of 13 038 cases. Int J Tuberc Lung Dis. 2005;9(4):430–6. 6. Jiménez-Fuentes MÁ, Rodrigo T, Altet MN, Jiménez-Ruiz CA, Casals M, Penas A, et al. Factors associated with smoking among tuberculosis patients in Spain. BMC Infect Dis. 2016;16(1):1–9. 7. Kombila UD, Mbaye FBR, Kane YD, Ka W, Badiane NOT. Particularités cliniques et radiologiques de la tuberculose pulmonaire chez le tabagique. Rev Mal Respir. 2018;4–11. 8. Fekih L, Boussoffara L, Abdelghaffar H, Hassene H, Fenniche S, Belhabib D, et al. Effet du tabagisme sur la tuberculose pulmonaire. Rev Med Liege. 2010;65(3):152–5. 9. Leung CC, Li T, Lam TH, Yew WW, Law WS, Tam CM, et al. Smoking and Tuberculosis among the Elderly in Hong Kong. Am J Respir Crit Care Med. 2004;170:1027–33. 10. Wang JY, Hsueh PR, Jan IS, Lee LN, Liaw YS, Yang PC, et al. The effect of smoking on tuberculosis: Different patterns and poorer outcomes. Int J Tuberc Lung Dis. 2007;11(2):143–9. 11. Yalçinsoy M, Güngör S, Afşar BB, Bilgin S, Akkaya E. The effect of smoking on the Course of Tuberculosis. Turk Toraks Derg. 2014;15(2):92–3. 12. Racil H, Amar J Ben, Cheikrouhou S, Hassine E, Zarrouk M, Chaouch N, et al. Particularités de la tuberculose pulmonaire chez le tabagique. Press Medicale. 2010;39(2):25–8. 13. Singla R, Osman MM, Khan N, Al-Sharif N, Al-Sayegh MO, Shaikh MA. Factors predicting persistent sputum smear positivity among pulmonary tuberculosis patients 2 months after treatment. Int J Tuberc Lung Dis. 2003;7(1):58–64. 14. Chang KC, Leung CC, Tam CM. Tuberculosis risk factors in a silicotic cohort in Hong Kong. Int J Tuberc Lung Dis. 2001;5:174–88. 15. Janah H, Souhi H, Kouissmi H, Marc K, Zahraoui R, Benamor J, et al. LA TUNISIE MEDICALE - 2021 ; Vol 99 (n°06) 643 La tuberculose pulmonaire et le tabac: à propos de 100 cas Case series Open Access. Pan African Med Journal-ISSN. 2014;19:1937–8688. 16. Singha A, Baruah C, Phukan C. Original Article clinico-radiological profile of tuberculosis among smokers attending rntcp facility at Gauhati medical college and hospital, Guwahati. J Evid Based Med Heal. 2016;3:3120–5. 17. Carette MF, Mizouni L, Amri A El, Korzek J, Khalil A. Imagerie typique et atypique de la tuberculose bronchopulmonaire. La Lett l’infectiologue. 2012;1993(figure 1):40–52. 18. Yeon JJ, Lee KS. Pulmonary tuberculosis: Up-to-date imaging and management. Am J Roentgenol. 2008;191(3):834–44. 19. Chaouir S, Mahi M, Semlali S, El Fenni J, Ben Ameur M. Apport de la tomodensitometrie dans la tuberculose thoracique chez 68 patients immunocompetents. Hôpital Mil d’Instruction. 2005;58. 20. Aziza R, Sanae H, Hatim K, Bourkadi JE. Pulmonary tuberculosis specificities in smokers. Egypt J Chest Dis Tuberc. 2015;64(4):929–32. 21. Nkengasong JN. Strengthening laboratory services and systems in resource-poor countries. Am J Clin Pathol. 2009;131(6):774. 22. Nasr S Ben, Chaouch N, Bacha S, Rouhou SC, Racil H, Zarrouk M, et al. La tuberculose étendue de l’immunocompétent : causes et conséquences . Pulmonary tuberculosis in immunocompetent : causes and consequenses. La Tunisie Medicale 2015;93:537–42. 23. Dheda K, Maier LA. Smoking is Not Beneficial for Tuberculosis. Am J Respir Crit Care Med. 2004;170(7):821–821. 24. Baumgartner KB, Samet JM, Stidley CA, Colby T V, Waldron JA, Centers C. Cigarette Smokinv : A Risk Fador for Idiopathic pulmonary fibrosis. AM J RESPIR CRIT CARE MED. 1997;9(17):242–8. 25. Wang MG, Huang WW, Wang Y, Zhang YX, Zhang MM, Wu SQ, et al. Association between tobacco smoking and drug-resistant tuberculosis. Infect Drug Resist. 2018;11:873–87. 26. Cailleaux-Cezar M, Loredo C, e Silva JRL, Conde MB. Impact of smoking on sputum culture conversion and pulmonary tuberculosis treatment outcomes in Brazil: A retrospective cohort study. J Bras Pneumol. 2018;44(2):99–105. 27. Metanat M, Sharifi-Mood B, Parsi M, Sanei-Moghaddam S. Effect of cigarette smoking on sputum smear conversion time among adult new pulmonary tuberculosis patients: A study from Iran Southeast. Iran J Clin Infect Dis. 2010;5(1):14–7. 28. Abal AT, Jayakrishnan B, Parwer S, El Shamy A, Abahussain E, Sharma PN. Effect of cigarette smoking on sputum smear conversion in adults with active pulmonary tuberculosis. Respir Med. 2005;99(4):415–20. 29. Underner M, Perriot J, Peiffer G, Ouedraogo G, Gerbaud L, Meurice J. Tabac et tuberculose maladie Smoking and active tuberculosis. Rev Mal Respir. 2012;29(8):978–93. 30. Hicks A, Muthukumarasamy S, Maxwell D, Howlett D. La tuberculose pulmonaire chronique inactive et les séquelles du traitement : caractéristiques de la radiographie pulmonaire. Int J Tuberc Lung Dis. 2014;18(2):128–33. 31. Millet JP, Orcau À, De Olalla PG, Casals M, Rius C, Caylà JA. Tuberculosis recurrence and its associated risk factors among successfully treated patients. J Epidemiol Community Health. 2009;63(10):799–804. 32. Racil H, Amar J Ben, Mami M, Chabbou A. Facteurs prédictifs des récidives de tuberculose pulmonaire en Tunisie. Rev Mal Respir. 2012;29(3):412–8. 33. Cremoux H De, Laurent P, Brochard F. Interactions between Cigarette Smoking and the Natural History of Idiopathic Pulmonary Fibrosis. Chest. 1990;98:71–6. 34. Bates MN. Risk of Tuberculosis From Exposure to Tobacco Smoke. Arch Intern Med. 2007;167(4):335. 35. Sitas F, Urban M, Bradshaw D, Kielkowski D, Bah S, Peto R. Tobacco attributable deaths in South Africa. Tob Control. 2004;13(4):396–9. 36. Pednekar MS, Gupta PC. Prospective study of smoking and tuberculosis in India. Prev Med (Baltim). 2007;44(6):496–8. 37. Zellweger J, Cattamanchi A, Sotgiu G. Tobacco and tuberculosis : could we improve tuberculosis outcomes by helping patients to stop smoking ? Eur Respir J. 2015;(45):583–5. 38. Pradeepkumar AS, Thankappan KR, Nichter M. Smoking among tuberculosis patients in Kerala , India : proactive cessation efforts are urgently needed summary. Int J Tuberc Lung Dis. 2008;12(May):1139–45. 39. J Perriot. La conduite de l’aide au sevrage tabagique. Rev Mal Respir. 2006; 23(1): 3585–105. 40. Slama K, Chiang C, Enarson DA. educational series : tobacco and tuberculosis Introducing brief advice in tuberculosis services. Int J Tuberc Lung Dis. 2007;11(5):496–9. 41. Amara B, Ghazi K El, Rahimi H, Elbiaze M, Nejjari C, Benjelloun MC. Attitudes et connaissances des pneumo-phtisiologues marocains visà-vis du tabagisme chez leurs patients tuberculeux. Rev Mal Respir. 2008;25(5):569–75.
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Child treatment diagnosis surgery prognosis Tunisia Children Crohn’s disease Breast cancer Cancer screening epidemiology Ulcerative colitis Osteoporosis prevention
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