Even light-use hookah or waterpipe smokers may develop lung function abnormalities, including marked changes in cells lining the airways, a new study has warned.
Few studies have assessed safety of smoking with a waterpipe, which delivers fruit-flavoured tobacco that is placed in a bowl and burned with charcoal.
Smoke from the tobacco is bubbled through water, carried through a hose and inhaled.
Light-use waterpipe smokers (who smoked no more than three bowls per week for fewer than five years), with an average age of 24, were recruited for the study.
Ronald Crystal, from the Weill Cornell Medicine in US, and colleagues assessed the effects of waterpipe smoking on study participants using clinical and biological parameters.
The clinical data showed that, compared to non-smokers, waterpipe smokers coughed more frequently and produced more sputum.
Biological changes were observed in “marked changes in the cells lining the airways” of waterpipe smokers.
In addition, the researchers noted an increase in the circulation of small particles shed by endothelial cells in the lungs.
“This is indicative of ongoing damage to the capillaries,” said Crystal.
Together, the clinical and biological changes associated with light-waterpipe use are signs of early lung damage.
According to the researchers, compared to one cigarette, one waterpipe session exposes the smoker to two to four times the amount of nicotine, seven to 11 times the amount of carbon monoxide, 100 times more tar and 17 times the amount of formaldehyde.
Hookah smokers were also exposed to two to five times the amount of high molecular weight carcinogenic polyaromatic hydrocarbons and three times the amount of phenol.
“This is a small study, but our study results justify initiating large epidemiologic studies to further assess the harmful effects of waterpipe smoking,” said Crystal.
“It is uncontrolled – there are no regulations pertaining to its use – and the data raises red flags that even limited use may cause lung damage,” he said.
The study was published in the American Journal of Respiratory and Critical Care Medicine.