Cardiopulmonary efficiency in gutkha chewers: An Indian study

Original Article Pakkala, et al.: Cardiopulmonary efficiency in gutkha chewers Journal of Medical Investigations and Practice / Vol 9 / Issue 2 / Apr-Jun 2014 75 use since 1970, its use is common in various parts of the world, including India and central Asia. An increase in consumption of smokeless tobacco has been noticed among high school, college students and sportspersons. Use of smokeless tobacco indeed represents a health concern of growing magnitude among these groups. As a consequence of its addictive qualities, the consumption of smokeless tobacco often becomes a lifelong habit with cumulative and deleterious effects on health. Despite the known health consequences of tobacco, “chewing” is not viewed by users as particularly dangerous and is considered less of a “social evil” than smoking by much of the public. Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risk and needs to be discouraged. Previous reports have described long term harmful effects of nicotine on various body parameters, little is known about acute effect of smokeless tobacco on cardiopulmonary parameters. The effect of tobacco smoking on aerobic capacity and their predisposition to various unfavorable risk factors for disease is well‐studied. There is paucity of studies indicating effect of use of gutkha, a common form of smokeless tobacco in India on cardiopulmonary parameters of youngsters. Aims and objectives This study has been undertaken to study the acute effect of gutkha chewing on cardiopulmonary efficiency tests in young healthy gutkha chewers when compared to age and sex matched nongutkha chewing healthy controls. A sample size of 40 was taken in the study group and control each. This was a time bound study; hence this sample size was selected for statistical reasons. This study was done in our physiology laboratory. The subjects were selected from the general public on an outreach basis. Informed consent was obtained from all participants. MATERIALS AND METHODS This study was conducted in the Exercise Physiology Lab of PES IMSR, Kuppam, India. Forty apparently healthy sedentary male gutkha chewers of age group 18‐25 years were taken as subjects and equal number of age and sex matched healthy nongutkha chewers were taken as controls. Ethical clearance was obtained from institution ethics committee. The subjects for the study were selected based on the following criteria. Inclusion criteria • Males between 18 and 25 years of age • Leading sedentary life • Chewing gutkha for 4‐5 years duration of five or more packets/day. Exclusion criteria • Age more than 25 years • Leading physically active lifestyle • Suffering from cardiopulmonary or systemic illness like diabetes, hypertension • Involved in any sports or exercise regimen • Addicted (dependence) to any drugs. The subjects for the control group were selected based on the following criteria. Inclusion criteria • Males between 18 and 25 years of age • Leading sedentary life • Not chewed even a single packet of gutkha up to the time of study. Exclusion criteria • Age more than 25 years • Leading physically active lifestyle • Suffering from cardiopulmonary or systemic illness such as diabetes, hypertension • Involved in any sports or exercise regimen • Addicted (dependence) to any drugs. Before starting the actual study subjects were briefed about the protocol and informed consent was obtained. Thorough history regarding suitability as per the above inclusion and exclusion criteria was elicited. Basic clinical examination was done to rule out any cardiopulmonary or other illness. Subjects were instructed to come to the lab and chew two packets of gutkha immediately before starting the recordings. Both controls and chewers were advised to refrain from consumption of coffee, tea and heavy meals at least 2 h prior to the recordings. Resting heart rate Resting heart rate (HR) was measured in both study and control group, with the help of Cardiart electrocardiograph (ECG) which is a single channel, 12 lead selection ECG, designed to record ECGs. Measurement was carried out only after the subjects were thoroughly acquainted with working of the corresponding instrument and the prescribed maneuver. Special instructions • The subject was made to rest for 15 min after the attachment of leads • He was instructed to remain in sitting posture and completely relaxed. The calibration (1 mv = 10 mm deflection height) and paper speed (25 mm/s) were checked. Lead selection was switched Pakkala, et al.: Cardiopulmonary efficiency in gutkha chewers Journal of Medical Investigations and Practice / Vol 9 / Issue 2 / Apr-Jun 2014 76 to lead‐II and ECG was taken. The resting HR was calculated and results were expressed as beats per minute.