Background: Tuberculosis and smoking represent a major global health problem that is well recognized in the Republic of Moldova and worldwide. There is strong relationship between social vulnerability and psychotropic substance abuse: tobacco smoking, alcohol abuse and illicit drug use. The aim of the study was the impact assessment of active tobacco smoking and associated determinants on evolution of pulmonary tuberculosis and treatment outcome. Material and methods: pulmonary TB patients diagnosed in the period 1.1.2014-31.12.2014 in Chisinau city were distributed in two groups: study group constituted 209 patients with pulmonary TB and active smoking and control group (CG) – 79 patients with pulmonary TB never-smokers. Results: Risk factors for development of active TB at smokers are poverty-related conditions, male sex, single matrimonial status, medico-biological conditions and alcohol addiction, low educational status, urban residence. Case-management of smokers with pulmonary TB was worsened by the lack of health insurance (two thirds), late detection and epidemiological danger due to positive bacillary smear status. Co-morbidities and TB-related radiomorphological features (bilateral localization, lung destructions, dissemination, and positive bacillary status) adjusted to risk factors contribute to low treatment outcome. Conclusions: Targeted interventions for smoking quitting in the frame of risk subgroups will diminish the rate of severe and complicated forms of TB and will increase success rate, strengthening TB control at the community level.