Pulmonary Abnormalities in Young, Light-Use Waterpipe (Hookah) Smokers

Am J Respir Crit Care Med. 2016 Sep 1;194(5):587-95. doi: 10.1164/rccm.201512-2470OC.


Rationale: Waterpipes, also called hookahs, are currently used by millions of people worldwide. Despite the increasing use of waterpipe smoking, there is limited data on the health effects of waterpipe smoking and there are no federal regulations regarding its use.

Objectives: To assess the effects of waterpipe smoking on the human lung using clinical and biological parameters in young, light-use waterpipe smokers.

Methods: We assessed young, light-use, waterpipe-only smokers in comparison with lifelong nonsmokers using clinical parameters of cough and sputum scores, lung function, and chest high-resolution computed tomography as well as biological parameters of lung epithelial lining fluid metabolome, small airway epithelial (SAE) cell differential and transcriptome, alveolar macrophage transcriptome, and plasma apoptotic endothelial cell microparticles.

Measurements and main results: Compared with nonsmokers, waterpipe smokers had more cough and sputum as well as a lower lung diffusing capacity, abnormal epithelial lining fluid metabolome profile, increased proportions of SAE secretory and intermediate cells, reduced proportions of SAE ciliated and basal cells, markedly abnormal SAE and alveolar macrophage transcriptomes, and elevated levels of apoptotic endothelial cell microparticles.

Conclusions: Young, light-use, waterpipe-only smokers have a variety of abnormalities in multiple lung-related biological and clinical parameters, suggesting that even limited waterpipe use has broad consequences on human lung biology and health. We suggest that large epidemiological studies should be initiated to investigate the harmful effects of waterpipe smoking.

Keywords: endothelial microparticles; pulmonary; smoking; transcriptome; waterpipe.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Carbon Monoxide / analysis
  • Carboxyhemoglobin / analysis
  • Case-Control Studies
  • Cell-Derived Microparticles / drug effects
  • Cotinine / urine
  • Cough / etiology
  • Cough / microbiology
  • Epithelial Cells / drug effects
  • Female
  • Forced Expiratory Volume / physiology
  • Humans
  • Lung / pathology*
  • Lung / physiopathology*
  • Male
  • Nicotine / urine
  • Pulmonary Alveoli / cytology
  • Pulmonary Alveoli / drug effects
  • Pulmonary Diffusing Capacity*
  • Smoking / adverse effects*
  • Sputum / chemistry
  • Sputum / drug effects
  • Thorax / diagnostic imaging
  • Tobacco Use Disorder / complications*
  • Tomography, X-Ray Computed
  • Transcriptome / drug effects*
  • Young Adult


  • Nicotine
  • Carbon Monoxide
  • Carboxyhemoglobin
  • Cotinine