Pulmonary abnormalities in young, light-use waterpipe (Hookah) smokers

Yael Strulovici-Barel, Renat Shaykhiev, Jacqueline Salit, Ruba S. Deeb, Anja Krause, Robert J. Kaner, Thomas L. Vincent, Francisco Agosto-Perez, Guoqing Wang, Charleen Hollmann, Vignesh Shanmugam, Ahmad M. Almulla, Hisham Sattar, Mai Mahmoud, Jason G. Mezey, Steven S. Gross, Michelle R. Staudt, Matthew S. Walters, Ronald Crystal

Research output: Contribution to journalArticle

14 Citations (Scopus)


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: Toassess the effects of waterpipe smoking on thehuman 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.

Original languageEnglish
Pages (from-to)587-595
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number5
Publication statusPublished - 1 Sep 2016
Externally publishedYes



  • Endothelial microparticles
  • Pulmonary
  • Smoking
  • Transcriptome
  • Waterpipe

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Strulovici-Barel, Y., Shaykhiev, R., Salit, J., Deeb, R. S., Krause, A., Kaner, R. J., Vincent, T. L., Agosto-Perez, F., Wang, G., Hollmann, C., Shanmugam, V., Almulla, A. M., Sattar, H., Mahmoud, M., Mezey, J. G., Gross, S. S., Staudt, M. R., Walters, M. S., & Crystal, R. (2016). Pulmonary abnormalities in young, light-use waterpipe (Hookah) smokers. American Journal of Respiratory and Critical Care Medicine, 194(5), 587-595. https://doi.org/10.1164/rccm.201512-2470OC