Case-control study to evaluate the role of smoking, alcohol abuse, intravenous drug abuse, tobacco use and biomass fuel exposure as risk factor in pulmonary tuberculosis

Libin Mathew, Naveen Pandhi, N. C. Kajal, Guneet .


Background: An association between smoking and tuberculosis disease has been shown in various studies, it is less clear to what extent smoking increases the risk of Mycobacterium tuberculosis infection. Therefore the aim of this study is to evaluate the role of smoking, alcohol abuse, intravenous drug abuse, tobacco use and biomass fuel exposure as a risk factor for the development of pulmonary tuberculosis.

Methods: This is a case control study and total 200 subjects will be included with 100 sputum smear positive pulmonary tuberculosis cases and 100 age and sex matched healthy subjects as controls. Data collected from both cases and controls using a proforma by enquiring smoking habits, alcohol abuse, intravenous drug abuse, biomass fuel exposure and documenting chest X-ray features.

Results: The study showed significant association between tuberculosis and smoking as a risk factor with beedi smoking, early age of starting smoking, increased duration and quantity of smoking increases risk for tuberculosis. There was significant association between intravenous drug abuse, biomass fuel exposure and risk of tuberculosis. There was no significant association in the study between alcohol abuse, tobacco chewing and tuberculosis, but heavy drinking and tuberculosis showed significant association. The study also showed significant association of cavitary lesion with smoking.

Conclusions: There is significant association between smoking, intravenous drug abuse, biomass fuel exposure and tuberculosis, since these risk factors impairs host immune defences that allows the development of active tuberculosis.


Alcohol abuse, Biomass fuel, Intravenous drug abuse, Pulmonary Tuberculosis, Smoking, Tobacco

Full Text:



Park K. Tuberculosis. In: Park's. Textbook of Preventive and Social Medicine. 25th ed. Jabalpur; M/S Banarsidas Bhanot; 2019:188.

World Health Organization 2019 Global Tuberculosis Report. Available at:

Dhingra VK. Introduction. In: Tuberculosis treatment and prevention. 1st ed. Peepee publishers and distributors, New Delhi. 2008: 1-2.

TB India 2017, Chapter 2 TB burden in India, pg no: 9. Available in:

Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997 May 24;349(9064):1498-504.

John RM. Tobacco consumption patterns and its health implications in India. Hlth Policy. 2005;71:213-22.

Yach D. Commentary: Tobacco Consumption in India. J Public Health Policy. 2003 Jan 1;24(3/4):246-50.

Tuberculosis Prevention Trial M. Trial of BCG vaccines in South India for tuberculosis prevention. Ind J Medi Res. 1980;72(Jul):1-74.

van Zyl Smit RN, Pai M, Yew WW, Leung CC, Zumla A, Bateman ED, et al. Global lung health: the colliding epidemics of tuberculosis, tobacco smoking, HIV and COPD. Europ Resp J. 2010 Jan 1;35(1):27-33.

Bates MN, Khalakdina A, Pai M, Chang L, Lessa F, Smith KR. Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis. Arch Internal Medi. 2007 Feb 26;167(4):335-42.

Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Medi. 2007 Jan;4(1):e20.

Houtmeyers E, Gosselink R, Gayan-Ramirez G, Decramer M. Regulation of mucociliary clearance in health and disease. Eur Resp J. 1999 May 1;13(5):1177-88.

Hocking WG, Golde DW. The pulmonary-alveolar macrophage. New Engl J Medi. 1979 Sep 20;301(12):639-45.

Sopori M. Effects of cigarette smoke on the immune system. Nature Rev Immunol. 2002 May;2(5):372-7.

North RJ, Jung YJ. Immunity to tuberculosis. Annu Rev Immunol. 2004 Apr 23;22:599-623.

Cosio MG, Saetta M, Agusti A. Immunologic aspects of chronic obstructive pulmonary disease. New England J Medi. 2009 Jun 4;360(23):2445-54.

Murin S, Bilello KS, Matthay R. Other smoking-affected pulmonary diseases. Clini Chest Medi. 2000 Mar 1;21(1):121-37.

Wang H, Yu M, Ochani M, Amella CA, Tanovic M, Susarla S, et al. Nicotinic acetylcholine receptor α7 subunit is an essential regulator of inflammation. Nature. 2003 Jan;421(6921):384-8.

Kolappan C, Gopi PG. Tobacco smoking and pulmonary tuberculosis. Thorax. 2002 Nov 1;57(11):964-6.

Den Boon S, Van Lill SW, Borgdorff MW, Verver S, Bateman ED, Lombard CJ, et al. Association between smoking and tuberculosis infection: a population survey in a high tuberculosis incidence area. Thorax. 2005 Jul 1;60(7):555-7.

Perez-Padilla R, Perez-Guzman C, Baez-Saldana R, Torres-Cruz A. Cooking with biomass stoves and tuberculosis: a case control study. Int J Tuberc Lung Dis. 2001 May 1;5(5):441-7.