Objective of the study: This review aims to systematize current data (2022-2025) on the relationship between tobacco smoking and tuberculosis, including epidemiological patterns, pathogenetic mechanisms, and the impact on treatment outcomes [1, 2]. Key points and conclusions: Analysis of numerous studies confirms that smoking is an independent and modifiable risk factor at all stages of tuberculosis infection – from initial exposure to the development of relapse [1, 2]. The progression of tuberculosis in smokers is primarily driven by a complex disruption of immune control, including damage to the lung epithelial barrier, suppression of alveolar macrophage function, and dysregulation of efferocytosis [4]. Epidemiological studies and meta-analyses demonstrate that smoking more than doubles the risk of developing active tuberculosis [1, 2], increases the likelihood of adverse treatment outcomes by approximately 23% [2, 3], and is associated with comorbid conditions such as depression [1]. Given the strong evidence base, the integration of smoking cessation programs into national tuberculosis control strategies represents a necessary and economically effective intervention [5]. Conclusion: The above findings indicate that, despite significant progress in understanding immunological mechanisms, the epidemiology and optimal approaches to the clinical management of smoking patients with tuberculosis – particularly those with drug-resistant forms – require further investigation [2, 3]. Keywords: smoking, pulmonary tuberculosis, drug-resistant tuberculosis, risk factor.