A Review of the Pulmonary and Health Impacts of Hookah Use

Ann Am Thorac Soc. 2019 Oct;16(10):1215-1219. doi: 10.1513/AnnalsATS.201902-129CME.


Hookah is a single-stemmed or multistemmed instrument for vaporizing and smoking flavored tobacco, whose smoke is passed through a water basin before inhalation. The use of hookah dates back centuries and is believed to have originated in India during the reign of Akbar the Great or the Safavid dynasty of Persia. Outside its native region, hookah smoking has gained popularity throughout the world, especially among younger people. There is generally a misconception among hookah users that it is less addictive than combustible cigarette smoking and that there is little to no nicotine content in hookah, with some even believing that certain additives impart health benefits. Although studies investigating the health hazards of hookah are rather limited, the inhaled smoke contains large quantities of nicotine, tar, carbon monoxide, polyaromatic hydrocarbons, heterocyclic compounds, carboxylic compounds, and various inorganic compounds such as heavy metals, all of which are found in combustible cigarette smoking. Regular hookah use is associated with an increased risk of obstructive lung disease as well as lung cancer and malignancies of the head and neck. This narrative review summarizes the available data on the health hazards of hookah, with an emphasis on pulmonary complications. Increased knowledge and awareness of hookah smoking among healthcare providers can potentially lead to better patient education and identification of at-risk populations.

Keywords: complications; hookah; lung; smoking.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases / etiology
  • Humans
  • Lung Diseases / etiology
  • Neoplasms / etiology
  • Nicotine / adverse effects*
  • Smoking Water Pipes*
  • Tobacco Use Cessation
  • Water Pipe Smoking / adverse effects*
  • Water Pipe Smoking / epidemiology*


  • Nicotine