Hookah: Lung Abnormalities

Water-pipe and hookah smokers show lung abnormalities, new research finds.


Campaign messages often focus on the harmful effects associated with cigarette smoking and rarely talk about the effects of hookah or water-pipe smoking. New evidence suggests water-pipe smoking may not be what it’s all cracked up to be.

A water-pipe is an instrument for smoking flavored tobacco. Tobacco is placed in a bowl and burned with charcoal. The smoke then passes through water and is brought through a hose to the user. This tradition originated in the Middle East and its popularity is growing here in the US.

New research showed lung abnormalities in light-use water-pipe smokers. This included marked changes in the cells lining the airways.

Lead researcher, Ronald Crystal, MD, professor and chairman of the Department of Genetic Medicine at Weill Cornell Medicine, and his colleagues studied the effects of water-pipe smoking on participants.

The researchers noticed that water-pipe smokers coughed more and produced more sputum, a mixture of saliva and mucus coughed up from the respiratory tract, than their nonsmoking counterpart. Water-pipe smokers experienced an increased circulation of small particles that were released by the endothelial cells within the lungs.

"This is indicative of ongoing damage to the capillaries,” Dr. Crystal said in a press release.

The author said that compared to one cigarette, one water-pipe session exposes the smoker to:

  • 2 to 4 times the amount of nicotine
  • 7 to 11 times the amount of carbon monoxide
  • 100 times more tar
  • 17 times the amount of formaldehyde
  • 2 to 5 times the amount of high molecular weight carcinogenic polyaromatic hydrocarbons
  • 3 times the amount of phenol

Due to the findings, Dr. Cystal said, "This is a small study, but our study results justify initiating large epidemiologic studies to further assess the harmful effects of water-pipe smoking. It is uncontrolled--there are no regulations of its use--and the data raises red flags that even limited use may cause lung damage."

The study results were published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

No conflicts of interest were disclosed.