A The leaf is from a broad leafed

A comparative study on the pulmonary manifestations of Bidi and cigarette smoking. INTRODUCTION:-Tobacco smoking is among the largest preventable causes of premature deaths globally. 1 India has over 100 million adult smokers, the second highest number of smokers in the world after China. There are already about 1 million adult deaths per year from smoking. 2 The harmful effects of cigarette smoking have been extensively studied and are universally accepted. Less is known about the health effects of non-cigarette tobacco products, such as Bidis which are commonly used in populations of low socioeconomic status. Bidis are inexpensive, small, hand-rolled tobacco products commonly smoked in south Asia.3  Bidis consist of finely ground, sun dried tobacco rolled in a brown, tendu leaf. The leaf is from a broad leafed plant (Diospyrus melanoxylon or Diospyrus ebemum) native to India. 4 Herbal and flavoured varieties of Bidis are made to appeal to young adults as”natural and safe”tobacco alternatives to cigarettes. This claim contrasts with the toxicology data which have shown higher ammonia, cyanide, benzopyrenes, nicotine, tar, and carbon monoxide levels delivered for a lower content of tobacco in Bidis than in cigarettes.3 The nicotine concentration in the tobacco of Bidi cigarettes (21.2 mg/g) was significantly greater than the tobacco from the commercial filtered (16.3 mg/g) and unfiltered cigarettes (13.5 mg/g).4 The breath CO level is significantly high in Bidi smokers compared to cigarette smokers.5OBJECTIVES:-The main objectives of our study are:1.  To study and compare various pulmonary signs and symptoms associated with Cigarette and Bidi smoking.2. To compare the incidence COPD in Bidi and cigarette smoking.3. To compare the results of various pulmonary function tests in non smokers and smokers (cigarette and Bidi).METHODOLOGY:-This is a cross sectional study which will be conducted over a period of two months April-May 2018 on cigarette and Bidi smokers visiting the Pulmonology out Patient Clinic in our tertiary care hospital. Institutional ethical committee clearance will be obtained for the study. Informed consent will be taken from the patients before performing the tests and collecting the samples.In the first step, pulmonary function tests of non smokers and smokers will be taken. Smokers will be further classified into cigarette and Bidi smokers and the difference in their capacities too will be noted and compared.In the second step, incidence of various pulmonary signs and symptoms like Shortness of breath (SOB), Cough and Patient’s vital data will be taken note and compared.In the third step, Chest X-rays will be taken and the lung morphology of cigarette and Bidi smokers will be compared. This will be followed by collection and microscopic examination of Sputum samples.In the fourth step, Carbon monoxide concentration in the breath will be compared using Bedfont Smokerlyzer. In the final step, the incidence of COPD in Bidi and cigarette smokers visiting our tertiary health centre will be compared.Exclusion criteria1. Persons who consume more than one type of tobacco product will be excluded from this study.2. Persons don’t smoke regularly and those who have started smoking recently will be excluded.HISTORYDetailed history of the patient will be obtained with special emphasis oni.) Pack years consumed.ii.) Brand of Cigarette/Bidi consumed.iii.) Age at which the person began smoking.iv.)Drug history and personal history including dietary habits and chewable tobacco consumption like paan, gutka etc.v.) Occupation, socioeconomic status and address (Rural/Urban).IMPLICATIONS:-Smoking today has attained the status of an important threat to human health. It has adverse affects on all the systems of the body of not just the smoker but also of the surrounding people as passive smokers. Bidi is the most of these due to higher concentration of nicotine, carbon monoxide etc. It is therefore a prime necessity of utmost importance to introduce a check on Bidi smoking. There are many false conceptions of Bidi being a healthier alternative due to its herbal look. The artificial flavouring of Bidis further promotes interest especially in teenagers and youth.There is no comprehensive and complete study proving the greater adverse effects of Bidi in comparison to the traditional cigarette. Therefore it is very important to recognise this and persuade governmental agencies to monitor the quality of Bidis.REFERENCES:-1.) Jha P, Peto R. Global effects of smoking, of quitting, and of taxing tobacco. N Engl J Med   2014;370:60–8.2.) Mishra S, Joseph RA, Gupta PC, et al. Trends in bidi and cigarette smoking in India from 1998 to 2015, by age, gender and education. BMJ Global Health 2016;1:e000005.doi:10.1136/bmjgh-2015-0000053.) MyLinh Duong, Sumathy Rangarajan, et al, Lancet Glob Health 2017; 5:e168–764.) Malson, Sims, Murty, et al, Comparison of the nicotine content of tobacco used in bidis and conventional cigarettes, Tobacco Control 2001;10:1815.) R. Kumar et al, Breath CO Concentration in Smokers, The Indian Journal of Chest Diseases & Allied Sciences, 2010;Vol.52,19-23