Background and objectives: Bidi, cigarette, hookah and chillum are common modes of tobacco smoking in India. Many people consider hookah and chillum smoking less toxic because smoke is filtered through water or wet cloth. We evaluated the toxicity of tobacco smoking by measuring end-tidal carbon monoxide (eCO) levels after various modes of smoking.
Methods: Eighteen healthy smokers who smoked bidi, cigarette, hookah and chillum on six days were studied. They smoked one bidi, one cigarette, five minutes hookah, one serve (15 minutes) hookah, five minutes chillum and one serve (15 minutes) chillum on six days randomly. The eCO values were measured before initiation of smoking and for a period of one hour after the smoking session. Increase in eCO values in comparison to baseline after different modes of smoking was compared.
Results: In comparison to baseline, mean eCO levels were raised by 4.94 (0.96) parts per million (ppm) immediately and 4.17 (1.07) ppm 60 minutes after cigarette smoking. Bidi smoking caused slightly less increase in mean eCO levels (3.17 [0.82]). One serve of hookah and chillum smoking caused elevation of mean eCO values by almost eight-folds higher than that of cigarette smoking. Five minutes of smoking with hookah (22.18 [5.29]) and one serve of hookah (33.0 [8.76]) and chillum (40.14 [12.73]) caused significantly higher values of mean increase in eCO in comparison to cigarette smoking (p<0.001).
Conclusion: With regard to eCO levels, hookah and chillum smoking are much more toxic than cigarette smoking.