Hookah pipe lung damage: Even light smokers show early signs of lung disease

Hookah smoking can lead to pulmonary abnormalities, even for light and intermittent smokers, researchers say. A single water-pipe session, as hookah smoking is also referred to, is equivalent to inhaling two to four times the amount of nicotine and a hundred times the amount of tar than when smoking a cigarette.

While more and more studies are being conducted to understand how hookah smoking affects the human body, there is still not a full consensus within the scientific community. This latest research, published in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, aims to bring new evidence to the debate, confirming the argument that water-pipes potentially carry more risks than traditional smoking.

More coughs, more pulmonary alterations
In this small study, the scientists have looked at light-use hookah smokers from New York, with an average age of 24. The team defined "light-use" as no more than three bowls a week, for less than five years.

They assessed the participants' health based on clinical as well as biological criteria. Clinical data showed that the smokers had more frequent coughs than non-smokers and produced more sputum.
Biological analysis revealed further abnormalities. The scientists observed "marked changes in the cells lining in the airways". Among other things, they noted that light smokers had reduced proportions of small airway epithelial cells and basal cells, which serve to moisten and protect the airways from foreign particles and infections.
Additionally, the researchers identified an increase in the circulation of small particles shed by another type of cells in the lungs, the endothelial cells. Both these clinical and biological signs indicate early lung damage.
"This is indicative of ongoing damage to the capillaries," says lead author, Dr Ronald Crystal.
More damage than one cigarette
In the second part of the research, Dr Crystal's team tried to quantify how much toxic products entered the body during a hookah smoking session. Compared to smoking just one cigarette, they write that a single water-pipe use corresponds to two to four times the amount of nicotine, seven to 11 times the amount of carbon monoxide, two to five times the amount of carcinogenic hydrocarbons, and 100 times the amount of tar.
Taken together, these numbers provide a first explanation of why hookah smoking can damage the lungs, even when an individual does not use the device on a daily basis. In the UK, 12% of the population has smoked a hookah pipe before, and 1% do so regularly.