Review

Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis

Volume: 4 Number: 2 September 14, 2026

Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis

Abstract

Tuberculosis (TB) and tobacco use are two major global health problems that are concentrated within the same populations, particularly in low- and middle-income countries, and mutually reinforce one another. Tobacco smoke weakens host defence against Mycobacterium tuberculosis by impairing mucociliary clearance, alveolar macrophage function, autophagy, antimicrobial responses, and T-cell-mediated immunity. Epidemiological evidence indicates that active smoking increases the risk of TB infection and disease, while clinical studies associate smoking with a higher bacillary burden, cavitary and extensive pulmonary involvement, delayed microbiological conversion, loss to follow-up, recurrence, and mortality. However, the association between smoking and drug resistance is multifactorial, and evidence supporting direct causality remains limited. Repeated contact with healthcare services during TB treatment provides a unique opportunity to deliver tobacco cessation interventions. Integrating brief counselling, behavioural support, pharmacotherapy, and mobile health interventions into TB programmes may improve both cessation success and long-term TB outcomes. This narrative review summarises current evidence on the epidemiology, biological mechanisms, clinical consequences, and integrated control strategies underlying the relationship between tobacco use and TB.

Keywords

Tuberculosis, tobacco use disorder, smoking, treatment outcome, smoking cessation

Ethical Statement

Not applicable; this is a narrative review of published literature.

References

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APA
Dülger, S., & Çetintaş Afşar, G. (2026). Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis. Journal of Bursa Faculty of Medicine, 4(2), 18-21. https://doi.org/10.61678/bursamed.2031615
AMA
1.Dülger S, Çetintaş Afşar G. Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis. J Bursa Med. 2026;4(2):18-21. doi:10.61678/bursamed.2031615
Chicago
Dülger, Seyhan, and Gülgün Çetintaş Afşar. 2026. “Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis”. Journal of Bursa Faculty of Medicine 4 (2): 18-21. https://doi.org/10.61678/bursamed.2031615.
EndNote
Dülger S, Çetintaş Afşar G (September 1, 2026) Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis. Journal of Bursa Faculty of Medicine 4 2 18–21.
IEEE
[1]S. Dülger and G. Çetintaş Afşar, “Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis”, J Bursa Med, vol. 4, no. 2, pp. 18–21, Sept. 2026, doi: 10.61678/bursamed.2031615.
ISNAD
Dülger, Seyhan - Çetintaş Afşar, Gülgün. “Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis”. Journal of Bursa Faculty of Medicine 4/2 (September 1, 2026): 18-21. https://doi.org/10.61678/bursamed.2031615.
JAMA
1.Dülger S, Çetintaş Afşar G. Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis. J Bursa Med. 2026;4:18–21.
MLA
Dülger, Seyhan, and Gülgün Çetintaş Afşar. “Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis”. Journal of Bursa Faculty of Medicine, vol. 4, no. 2, Sept. 2026, pp. 18-21, doi:10.61678/bursamed.2031615.
Vancouver
1.Seyhan Dülger, Gülgün Çetintaş Afşar. Two Global Epidemics: The Interrelationship Between Tobacco Dependence and Tuberculosis. J Bursa Med. 2026 Sep. 1;4(2):18-21. doi:10.61678/bursamed.2031615