Can smoking reduce the incidence and prevalence of non-tuberculous mycobacterial pulmonary disease?

Smoke inhalation has a strong association with the incidence of tuberculosis (TB), besides other factors. Tobacco smoke is found to be the strongest factor. However, it is not well established whether tobacco smoke increases the incidence or delays the treatment success. Nevertheless, it is well known that tobacco smoke has a strong association with the incidence and severity of TB, and smokers have higher odds of TB-related mortality and irrespective of the species of the causative agent – the Mycobacterium tuberculosis or non-tuberculous mycobacteria (NTM). Unfortunately, one recent publication attracted our attention, in which the authors have claimed that current tobacco smokers and current heavy smokers were at lower risk for NTM pulmonary disease development than non-smokers. Here, we present our opinion and strongly opine that such conclusion based on skewed data and its misleading interpretation may not be published in peer-reviewed journals.