Anthracosis is pneumoconiosis induced by frequent contact with smoke from biomass, air pollution, charcoal smoke, or dust particles. This study aimed to investigate the association between anthracosis and pulmonary tuberculosis. In this cross-sectional study, 401 patients undergoing bronchoscopy were recruited, and their demographic characteristics, clinical features, bronchoscopy and imaging results, pathologic-cytologic reports, and acid-fast bacilli (AFB) smear were recorded and analyzed. Bronchoscopic results of 220 patients (54.9%) were normal, 93 (23.2%) had anthracosis, and 32 patients (8%) had anthracofibrosis. Positive pulmonary tuberculosis was significantly higher in patients with anthracosis or anthracofibrosis compared to those without (17.6% vs. 4%) (OR=5.09, P<0.001). Patients with tuberculosis and anthracosis or anthracofibrosis had more prolonged contact with biomass (P=0.002). Logistic regression showed age (P=0.003) and the presence or absence of anthracosis or anthracofibrosis (P=0.006) as associated factors with pulmonary TB. Anthracosis is associated with other pulmonary diseases, including TB; therefore, in case anthracosis or anthracofibrosis is diagnosed, the coincidental pulmonary TB should also be evaluated.