Tuberculosis and Tobacco

The association between tobacco use and tuberculosis (TB) outcomes have long been suspected. More recent studies have provided evidence for causal association between active and passive tobacco smoking and a range of TB outcomes including infection, development of disease, treatment outcomes, relapse as well as mortality.

Tobacco smoking has not been recognized as one of the challenges for TB control. The clinicians treating tuberculosis have also overlooked the adverse association between tobacco and TB.To reverse this situation, WHO Tobacco Free Initiative (TFI) and WHO Stop TB! (STB), in collaboration with the International Union Against Tuberculosis and Lung Diseases (UNION), resolved to integrate tuberculosis (TB) and tobacco control activities within district-level health systems in 2004. The new Stop TB strategy recognizes that prevention of the most frequent risk factors is an important contributor for TB control.

The Stop TB Strategy has 6 components and the 3rd component of this strategy (Contribute to health system strengthening) has Practical Approach to Lung Health (PAL) as its 2nd subcomponent (Share innovations that strengthen systems, including the PAL).

PAL is a syndromic approach to the management of patients who attend primary health care services for respiratory symptoms. The PAL strategy targets multi-purpose health workers, nurses, doctors and managers in primary health care settings with successful TB control programmes in low and middle-income countries.

PAL provides an important opportunity for effective TB control, it also provides access to patients in the health system and this in turn, offers opportunities for tobacco control. Patients accessing a health facility centre are more attentive and receptive to behavioral change. Therefore, tobacco cessation counseling can be very effective making an impact on both TB and tobacco control in the long run.

Integration of tobacco cessation activities with the PAL  into TB control programmes will significantly curb the epidemic and will therefore contribute to reaching the 2015 Millennium Development Goal related to TB control. It is therefore, important for WHO to advise MoH and provide necessary support for close collaboration between Tobacco and TB control programmes. Both technical and financial support for the integration of tobacco control elements in TB control programme is available from a number of donors through WHO.

In 2006, the eleven Member countries in the South-East Asia Region  together notified 2 203 456 cases of tuberculosis (all forms) which represents 133 per 100 000 population. Five countries in the Region – Bangladesh, India, Indonesia, Myanmar and Thailand which belong to the global list of 22 countries with the highest burdens of TB, notified 96% of all cases in the Region.

Currently a pilot project on TB tobacco using PAL is being implemented in Nepal.WHO. Indonesia Country Office, WHO SEARO and TFI/HQ are planning to implement the second pilot project on TB and tobacco in the Region in Indonesia in the 2008-2009 biennium

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