Evaluation of Lung Volume and Effect of Vital Staining as Motivation to Quit Tobacco among Nicotine Dependents of Kanpur, India


  • Amit Kumar
  • Ramesh Nagarajappa
  • Gayathri Ramesh
  • Vishal Chandra
  • Ravish Ahuja
  • Anurag Azad


Lung Volume Measurements, Nicotine, Spirometry, Tobacco


Objective: To quantify and compare respiratory functions and further screen the oral mucosa of tobacco and non-tobacco users. Material and Methods: First control group, non-tobacco users (n=55); Second group, smokers’ group (n=168) who currently smoked cigarettes; Third group smokeless/chewing type, tobacco group (n=81); Fourth group, both smokeless and smoking type tobacco users (n=46). Fagerstrom Test for Nicotine Dependences (FTND) and Fagerström Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST) instruments were used to assess nicotine dependence. Subsequently, spirometry and Toluidine Blue (TB) vital staining were performed. Chi-squared and one-way analysis of variance (ANOVA) were used for statistical analysis. Results: Fagerstrom test resulted in 48.8% of subjects with low dependency, followed by an increase in nicotine dependency from low to moderate (29.2%), moderate (15.6%), and highly dependent (6.4%) groups. All respiratory function tests and oral screening confirmed significant changes amongst tobacco and non-tobacco users. The forced vital capacity of non-smoker group was significantly different from other tobacco users’ group (p<0.05). Conclusion: Early effects of tobacco use can lead to complications with the respiratory system and oral cavity. Such data can be used to delineate the harm of tobacco and should be used to urge individuals to evade the utilization of tobacco.


National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014.

Moll JM, Wright V. An objective clinical study of chest expansion. Ann Rheum Dis 1972; 31(1):1-8. https://doi.org/10.1136/ard.31.1.1

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi F, Coates A. Standardisation of spirometry. Eur Respir J 2005; 26(2):319-38. https://doi.org/10.1183/09031936.05.00034805

Kuperman AS, Riker JB. The variable effect of smoking on pulmonary function. Chest 1973; 63(5):655-60. https://doi.org/10.1378/chest.63.5.655

Zamel N, Altose MD, Speir WA. Statement on spirometry: a report of the section of respiratory pathophysiology of the American College of Chest Physicians. J Asthma 1983; 20(4):307-11. https://doi.org/10.3109/02770908309077089

Walter S, Nancy NR, Collier CR. Changes in the force expiratory spirogram in young male smokers. Am Rev Respir Dis 1979; 119(5):717-24. https://doi.org/10.1164/arrd.1979.119.5.717

Hegde MC, Kamath PM, Shreedharan S, Dannana NK, Raju RM. Supravital staining: It's role in detecting early malignancies. Indian J Otolaryngology Head Neck Surg 2006; 58(1):31-4. https://doi.org/10.1007/BF02907735

Lingen MW, Kalmar JR, Karrison T, Speight PM. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol 2008; 44(1):10-22. https://doi.org/10.1016/j.oraloncology.2007.06.011

Epstein JB, Scully C, Spinelli J. Toluidine blue and Lugol's iodine application in the assessment of oral malignant disease and lesions at risk of malignancy. J Oral Pathol Med 1992; 21(4):160-3. https://doi.org/10.1111/j.1600-0714.1992.tb00094.x.

Epstein JB, Oakley C, Millner A, Emerton S, van der Meij E, Le N. The utility of toluidine blue application as a diagnostic aid in patients previously treated for upper oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83(5):537-47. https://doi.org/10.1016/s1079-2104(97)90117-7

Gandalfo S, Pentenero M, Broccoletti R, Pagano M, Carrozzo M, Scully C. Toluidine blue uptake in potentially malignant lesions in vivo: clinical and histological assessment. Oral Oncol 2006; 42(1):89-95. https://doi.org/10.1016/j.oraloncology.2005.06.016

Ryan H, Trosclair A, Gfroerer J. Adult current smoking: differences in definitions and prevalence estimates – NHIS and NSDUH, 2008. J Environ Public Health 2012; 2012:918368. https://doi.org/10.1155/2012/918368

Nelson DE, Mowery P, Tomar S, Marcus S, Giovino G, Zhao L. Trends in smokeless tobacco use among adults and adolescents in the United States. Am J Public Health 2006; 96(5):897-905. https://doi.org/10.2105/AJPH.2004.061580

Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict 1991; 86(9):1119-27. https://doi.org/10.1111/j.1360-0443.1991.tb01879.x

Ebbert JO, Patten CA, Schroeder DR. The Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST). Addict Behav 2006; 31(9):1716-21. https://doi.org/10.1016/j.addbeh.2005.12.015

Miller MR, Crapo R, Hankinson J, Brusasco F, Burgos R, Casaburi A, et al. General considerations for lung function testing. Eur Respir J 2005; 26(1):153-61. https://doi.org/10.1183/09031936.05.00034505

Donny EC, Denlinger RL, Tidey JW, Koopmeiners JS, Benowitz NL, Vandrey RG, et al. Randomized trial of reduced-nicotine standards for cigarettes. N Engl J Med 2015; 373(14):1340-9.

Langhammer A, Johnsen R, Holmen J, Gulsvik A, Bjermer L. Cigarette smoking gives more respiratory symptoms among women than among men. The Nord-Trondelag Health Study (HUNT). J Epidemiol Community Health 2000; 54(12):917-22. https://doi.org/10.1136/jech.54.12.917

Xu X, Dockery DW, Ware JH, Speizer FE, Ferris Jr BG. Effects of cigarette smoking on rate of loss of pulmonary function in adults: a longitudinal assessment. Am Rev Respir Dis 1992; 146 (5 Pt 1):1345-8. https://doi.org/10.1164/ajrccm/146.5_Pt_1.1345

Pallagatti S, Sheikh S, Aggarwal A, Gupta D, Singh R, Handa R, et al. Toluidine blue staining as an adjunctive tool for early diagnosis of dysplastic changes in the oral mucosa. J Clin Exp Dent 2013; 5(4):e187-91. https://doi.org/10.4317/jced.51121

Shukla A, Singh NN, Adsul S, Kumar S, Shukla D, Sood A. Comparative efficacy of chemiluminescence and toluidine blue in the detection of potentially malignant and malignant disorders of the oral cavity. J Oral Maxillofac Pathol 2018; 22(3):442. https://doi.org/10.4103/jomfp.JOMFP_261_17




How to Cite

Kumar, A. ., Nagarajappa, R. ., Ramesh, G. ., Chandra, V. ., Ahuja, R. ., & Azad, A. . (2022). Evaluation of Lung Volume and Effect of Vital Staining as Motivation to Quit Tobacco among Nicotine Dependents of Kanpur, India. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 22, e210102. Retrieved from https://revista.uepb.edu.br/PBOCI/article/view/1353



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