Pulmonary tuberculosis and smoking: When two public health problems converge

<bold>Introduction:</bold> Smoking weakens the lung's infection defense, elevating risks of Mycobacterium tuberculosis infection and treatment-related side effects. <bold>Objective:</bold> to study smoking's impact on anti-tuberculosis treatment toxicity. <bold>Methods:</bold> Retrospective comparative study of 90 bacteriologically confirmed pulmonary tuberculosis cases at Pneumology Department3, Abderrahmane Mami Ariana Hospital. Groups: G1 (56 smoking patients), G2 (34 non-smokers). <bold>Results:</bold> Population mean age was 45±18 years, M/F ratio=5.43. Pulmonary tuberculosis prevailed (56.7%). Smoking noted in 62.2% cases. G1 was younger (G1=45 vs. G2=47 years), with significant male dominance (p<10^-3) and more comorbidities (p<10^-3). Smokers had a longer median consultation time (p=0.009). Tuberculosis signs were more common in G1, but not significantly (p=0.29). Hemoptysis occurred more in G1 (p=0.002). G1 had extensive, excavated, infiltrative, and bilateral radiological lesions than G2 (p=0.06). Side effects to anti-tuberculosis treatment occurred in 48%, dominated by digestive disorders (p=0.001) and hepatic cytolysis (p=0.039) in G1. Pruritus, nephropathy, neuropathy, ophthalmological, and hematological disorders had comparable frequencies. Delayed bascilloscopy negativation was more frequent in G1 (p=0.01). Rates of sequelae, therapeutic failure, and resistance were similar. <bold>Conclusion:</bold> Smoking exacerbates anti-tuberculosis treatment side effects; cessation is crucial for reducing side effects and improving outcomes.