Integrating tobacco control in lung health services: Synergistic health outcomes!

Dr Tara Singh Bam, The Union
Photo credit: CNS:
[CNS Video] Despite strong evidence associating tobacco use with lung diseases, specific lung health programmes are yet to get fully integrated with tobacco control services. "When we provide tobacco cessation services in TB clinics we also reduce the risk of TB, asthma, cancers, cardiovascular diseases (CVDs) and other lung health diseases attributed to tobacco use significantly - not just for that person but also for those adversely impacted by her or his secondhand smoke! This is also a way to link health promotion from an individual to family and then to wider community" said Dr Tara Singh Bam, Technical Advisor (Tobacco Control) at the International Union Against Tuberculosis and Lung Disease (The Union).

[Watch CNS interview with Dr Bam here] Dr Bam spoke with Citizen News Service (CNS) at 5th Asia Pacific Region Conference on Lung Health in Sydney, Australia. "We have strong examples from China, Bangladesh, India, Indonesia, and other countries, where integration of smoking cessation services in TB control programmes has shown to offer healthy environment in the patient’s home too. Health system offers this package to individual patients and patients help create healthy environment within their homes. This also helps prevent diseases, disabilities and deaths associated with secondhand smoke."

It is a unique opportunity we should not miss: Dr Bam

According to the World Health Organization (WHO) tobacco kills up to half of its users. Tobacco kills around 6 million people each year. More than 5 million of those deaths are the result of direct tobacco use while more than 600,000 are the result of non-smokers being exposed to secondhand smoke.

"Tobacco control is very important for this conference as over 50% of tobacco users are in the Asia Pacific region. Over 30% of tobacco-related deaths also happen in Asia Pacific. Most of the high burden TB countries also belong to this region for example: China, India, Indonesia, Cambodia, Viet Nam, Myanmar, Philippines, among others. So high burden TB and tobacco countries are all in Asia Pacific. The Union has provided right opportunity to discuss TB and tobacco together – and identify ways how to fight these two collaboratively. When we speak of TB and tobacco use in Asia Pacific, we may be speaking about one individual – so we need to look into how to provide comprehensive and holistic lung health package to the individual. This is a unique opportunity which TB control can provide. If we can prevent tobacco use we can also reduce the risk of TB and other lung diseases" said Dr Bam.

Tobacco control also improves TB programme outcomes!

A new study published in September 2015 in International Journal of TB and Lung Disease also presents more evidence of public health gains of integrating tobacco control in TB and TB-HIV programmes. Smoking is associated with TB infection, TB disease and poorer anti-TB treatment outcomes.

"Integrating comprehensive tobacco control into TB control programmes will enhance TB control programme outcomes too. For example, it will prevent relapse, it will prevent TB treatment failures, and will also help prevent drug resistant forms of TB. Also tobacco control is a cost-effective measure."

Tobacco smoking has been identified as a major cause for delay in TB diagnosis and TB treatment. "We have increasing evidence from countries such as Nepal and Indonesia that tobacco smokers are having significant delays - of 3 months or more - before they get diagnosed for TB or get proper treatment as they often think that their cough is because of their tobacco smoking. If we have to cut the chain of TB transmission in a community it means that we need to bring in presumptive cases of TB as early as possible into the health facilities where accurate diagnosis can be made and effective treatment can be provided as needed. For me, if we are serious about ending TB we need to end tobacco first" emphasized Dr Bam.

The sustainable development framework for post 2015 which may get adopted this month includes tobacco control. One of the draft sustainable development goals (SDGs) have clearly mandated governments to implement the global tobacco treaty - formally called the WHO Framework Convention on Tobacco Control (WHO FCTC).


"We should not see tobacco merely as a risk factor, as it is directly associated with so many life-threatening diseases. Tobacco kills its users in different ways - by causing them cardiovascular diseases, cancers, TB, and other such deadly diseases. Individual tobacco user has to pay, family has to pay, community has to pay, and the impact is a disaster. That is why I call it as tobaccosis" said Dr Bam. Rightly so!

Bobby Ramakant, Citizen News Service - CNS
2 September 2015
(The author is providing thematic coverage from the 5th Asia Pacific Region Conference on Lung Health, of the International Union Against Tuberculosis and Lung Disease (The Union). He is supported by the Lilly MDR TB Partnership. Follow him on Twitter: @CNS_Health and @bobbyramakant)