Background: Smoking is one of the most important yet modifiable risk factors for incidence, morbidity, recurrence and mortality from Pulmonary Koch’s or tuberculosis. This study attempted to demonstrate the association between smoking and recurrence risk of Pulmonary Koch’s in Pakistani male population. Methods: This case control study was conducted at Federal Government Tuberculosis Hospital, Rawalpindi from 2015 to 2016. It included 332 study participants; 166 recurrent cases of Pulmonary Tuberculosis within two years of completion of Anti-tuberculous therapy (ATT) and 166 non-recurrent controls. Smoking status of all study participants was assessed. Results: Amongst 166 cases of recurrence, 75 (63.6%) had continued smoking after ATT compared to 43 (36.4%) controls who continued smoking (p-value 0.00, OR=2.35, 95% CI=1.48 to 3.74, NNH=4.75). Highly statistically significant associations of recurrence were observed with smoking>10 years (p-value 0.00, OR=3.67, CI=1.55–8.71 NNH=4.75) and if ever smoked in life (p-value 0.00, OR=2.05, CI=1.32–3.19, NNH=5.61). Mean duration of smoking in cases (12.37±8.72 years) was statistically different from controls (9.54±7.01 years), with p-value of 0.04. Conclusion: There is strong association of recurrence of Pulmonary Kochs with continuation of smoking within 2 years of completion of ATT, with ever smoking in life and smoking >10 years in life.Keywords: Pulmonary; Tuberculosis; Smoking; Cigarette smoking; Recurrence

Author Biographies

Darakhshan Ahmad, Holy Family Hospital Rawalpindi Medical College


Muhammad Mujeeb Khan, Holy Family Hospital Rawalpindi Medical College

Assistant ProfessorDepartment of Infectious Diseases, Holy Family Hospital. 

Faiza Aslam, Rawalpindi Medical College

Research Coordinator Rawalpindi Medical College

Sundas Abbas, Rawalpindi Medical College

Rawalpindi Medical College

Qurrat-ul-ain Elahi, Holy Family Hospital Rawalpindi Medical College



CDC. Tuberculosis (TB) Data and Statistics. [Internet]. [cited 2016 Apr]. Available from:

Kumar V, Abbas A, Fausto N, Mitchell R. Robbins Basic Pathology 8th ed. Philadelphia: W.B. Saunders Elsevier; 2007.

WHO. Global TB report 2015. [Internet]. [cited 2016 Apr]. Available from:

WHO. Pakistan Stop Tuberculosis. [Internet] [cited 2016 Apr].

Vree M, Huong NT, Duong BD, Sy DN, Van LN, Hung NV, et al. Survival And Relapse Rate Of Tuberculosis Patients Who Successfully Completed Treatment in Vietnam. Int J Tuberc Lung Dis 2007;11(4):392–7.

Datiko DG, Lindtjørn B. Tuberculosis recurrence in smear-positive patients cured under DOTS in southern Ethiopia: Retrospective cohort study. BMC Public Health 2009;9:348.

Crofts JP, Andrews NJ, Barker RD, Delpech V, Abubakar I. Risk Factors for Recurrent Tuberculosis in England and Wales, 1998-2005. Thorax 2010;65(4):310–14.

Moosazadeh M, Bahrampour A, Nasehi M, Khanjani N. The incidence of recurrence of tuberculosis and its related factors in smear-positive pulmonary tuberculosis patients in Iran: A retrospective cohort study. Lung India 2015;32(6):557–60.

Millet JP, Shaw E, Orcau À, Casals M, Miró JM, Caylà JA, et al. Tuberculosis Recurrence after Completion Treatment in a European City: Reinfection or Relapse? PLoS One 2013;8(6):e64898.

Verver S, Warren RM, Beyers N, Richardson M, van der Spuy GD, Borgdorff MW, et al. Rate of Reinfection Tuberculosis After Successful Treatment is Higher than Rate of New Tuberculosis. Am J Respir Crit Care Med 2005;171(12):1430–35.

Yen YF, Yen MY, Lin YS, Lin YP, Shih HC, Li LH, et al. Smoking Increases Risk of Recurrence after Successful Anti-Tuberculosis Treatment: A Population-Based Study. Int J Tuberc Lung Dis 2014;18(4):492–8.

Millet JP, Orcau A, 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.

Przybylski G, Dabrowska A, Gołda R, Gadzińska A, Trzcinska H. The Analysis of Smoking Tobacco of Patients with Tuberculosis--Data from Ten Years Observation in Regional Center of Pulmonology in Bydgoszcz. Przegl Lek 2012;69(10):953–57.

Jee SH, Golub JE, Jo J, Park IS, Ohrr H, Samet JM. Smoking and Risk of Tuberculosis Incidence, Mortality, and Recurrence In South Korean Men and Women. Am J Epidemiol 2009;170(12):1478–85.

Gajalakshmi V, Peto R, Kanaka TS, Jha P. Smoking And Mortality From Tuberculosis And Other Diseases In India: Retrospective Study Of 43000 Adult Male Deaths And 35000 Controls. Lancet 2003;362(9383):507–15.

d’Arc Lyra Batista J, de Fatima Pessoa Militao de Albuquerque M, de Alencar Ximenes RA, Rodrigues LC. Smoking increases the risk of relapse after successful tuberculosis treatment. Int J Epidemiol 2008;37(4):841–51.

Thomas A, Gopi PG, Santha T, Chandrasekaran V, Subramani R, Selvakumar N, et al. Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India. Int J Tuberc Lung Dis 2005;9(5):556–61.

Leung CC, Yew WW, Chan CK, Chang KC, Law WS, Lee SN, et al. Smoking adversely affects treatment response, outcome and relapse in tuberculosis. Eur Respir J 2015;45(3):738–45.

Anaam MS, Ibrahim MI, Al Serouri AW, Bassili A, Aldobhani A. A nested case-control study on relapse predictors among tuberculosis patients treated in Yemen's NTCP. Public Health Action 2012;2(2):168–73.

Khanna A, Lohya S, Sharath BN, Harries AD. Characteristics and treatment response in patients with tuberculosis and diabetes mellitus in New Delhi, India. Public Health Action 2013;3(Suppl 1):S48–50.

Gounder S, Harries AD. Screening tuberculosis patients for diabetes mellitus in Fiji: Notes from the field. Public Health Action 2012;2(4):145–7.

Wen CP, Chan TC, Chan HT, Tsai MK, Cheng TY, Tsai SP. The Reduction of Tuberculosis Risks by Smoking Cessation. BMC Infect Dis 2010;10:156.

World Heath Organization: Global tuberculosis control 2009: epidemiology, strategy, financing. 2010, Geneva, Switzerland, WHO/HTM/TB/2009.411,

Lin HH, Ezzati M, Chang HY, Murray M. Association between tobacco smoking and active tuberculosis in Taiwan: prospective cohort study. Am J Respir Crit Care Med 2009;180(5):475–80.

Boelaert JR, Gomes MS, Gordeuk VR. Smoking, iron and tuberculosis. Lancet 2003;362(9391):1243–4.

Davies PD, 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(4):291–8.

Wang J, Shen H. Review of cigarette smoking and tuberculosis in China: intervention is needed for smoking cessation among tuberculosis patients. BMC Public Health 2009;9:292.

Ng N, Padmawati RS, Prabandari YS, Nichter M. Smoking behavior among former tuberculosis patients in Indonesia: intervention is needed. Int J Tuberc Lung Dis 2008;12(5):567–72.



Most read articles by the same author(s)