Smoking, Air Pollution, Diabetes, and Post-Treatment Complications

· Risk Factors for COPD, Lung Cancer, and Tuberculosis (TB):

• Tobacco smoking and indoor air pollution from solid-fuel use are major global contributors to COPD, lung cancer, and TB.
• Smoking exacerbates TB severity and spread.
• Reducing smoking and solid-fuel use through taxation, advertising bans, and fuel pricing could lower COPD, lung cancer, and TB mortality.

· Economic Burden and Targeted Programs:

• These diseases disproportionately affect low-income or marginalized communities, imposing heavy economic burdens due to healthcare costs and reduced labor participation.
• Programs targeting low-income groups could offer cleaner fuels, stoves, nutritional supplements, and TB testing with treatment adherence incentives.
• Revenue from tobacco taxes could subsidize clean energy technologies, TB treatment programs (e.g., DOTS), and nutrition programs.

· TB Diagnosis and Health System Delays (HSD):

• TB diagnosis in Taiwan relies on symptomatic detection, with contact tracing and active screening for high-risk groups.
• Delayed TB diagnosis (HSD) is influenced by factors such as patient age, gender, healthcare facility type, travel distances, and "doctor shopping."
• Regions like Eastern Taiwan, with higher densities of TB-specialized providers, show shorter HSDs.
• Longer HSDs occur in medical centers due to more frequent comorbidities complicating TB diagnosis.

· TB and Diabetes Mellitus (DM):

• TB and DM are closely linked, particularly in countries like Indonesia, which ranks third in TB incidence and fourth in DM prevalence.
• TB patients with DM exhibit more symptoms but do not show increased severity in diagnostic tests.
• Diabetic TB patients adhere better to treatment but face complications like higher positive sputum culture rates after six months.

· Air Pollution and TB Risk:

• Exposure to PM2.5, PM10, and NO2 increases the risk of TB, with pollutants facilitating pathogen entry and impairing immune function.
• PM exposure disrupts respiratory cell iron balance and damages T-cell function.
• Reducing air pollution could help prevent TB by improving immune defenses.

· Post-TB Treatment Complications:

• Over half of TB survivors suffer from chronic respiratory issues such as abnormal lung function, bronchiectasis, and increased lung cancer risk.
• TB survivors have reduced exercise capacity, breathlessness, and are at higher risk for lung cancer post-treatment.
• Future research should focus on measuring post-TB disability and exploring management strategies to limit long-term disability.

Sources:

1. Lin, H.H., Murray, M., Cohen, T., Colijn, C. and Ezzati, M., 2008. Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: a time-based, multiple risk factor, modelling study. The Lancet, 372(9648), pp.1473-1483.
2. Chen, C.C., Chiang, C.Y., Pan, S.C., Wang, J.Y. and Lin, H.H., 2015. Health system delay among patients with tuberculosis in Taiwan: 2003–2010. BMC infectious diseases, 15, pp.1-9.
3. Alisjahbana, B., Sahiratmadja, E., Nelwan, E.J., Purwa, A.M., Ahmad, Y., Ottenhoff, T.H., Nelwan, R.H., Parwati, I., Meer, J.W.V.D. and Crevel, R.V., 2007. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clinical infectious diseases, 45(4), pp.428-435.
4. Lu, J.W., Mao, J.J., Zhang, R.R., Li, C.H., Sun, Y., Xu, W.Q., Zhuang, X., Zhang, B. and Qin, G., 2023. Association between long-term exposure to ambient air pollutants and the risk of tuberculosis: A time-series study in Nantong, China. Heliyon, 9(6).
5. Taylor, J., Bastos, M.L., Lachapelle-Chisholm, S., Mayo, N.E., Johnston, J. and Menzies, D., 2023. Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysis. EClinicalMedicine, 59.

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