Is hookah really even more dangerous than cigarettes? Answered by candidate of medical sciences

Head of the pathomorphologic laboratory of LabQuest Company, Ph.

“Tobacco use in its various forms has invariably accompanied mankind since ancient times. Hookah is one of the oldest tobacco smoking accessories that have survived to our time. It attracts smokers with a variety of mixtures, accompanying rituals and allegedly less harmful than cigarettes. I will tell you what the device is actually harmful and why it is not as harmless as it may seem at first glance”.

• Difference between cigarettes and hookah

• Harm of smoking hookah

Difference between cigarettes and hookah

Unlike a cigarette, where the only barrier between the smoldering tip and the lungs is a filter, in the case of a hookah the smoke passes through a liquid and a system of tubes – this cools and cleans the smoke. In addition, the smoker has the opportunity to directly influence both the temperature of smoldering tobacco and the air draft through different ways of “filling” the bowl with smoking mixture and special coals.

It is on the coals it is worth to stop in detail – they make a significant contribution to the harm from smoking hookah. The fact is that when burning coal emits CO – carbon monoxide. This chemical compound has one very unpleasant property – its molecules bind to hemoglobin, forming methemoglobin.

Without going into too much detail, hemoglobin is what carries oxygen through the tissues of our body, allowing them to “breathe”. The problem is that the bond of CO to hemoglobin is stronger than the bond of oxygen to the same. For this reason, methemoglobin begins to displace hemoglobin, which carries the oxygen our tissues and organs need. The result – the body begins to “suffocate” or, scientifically speaking, experience a state of tissue hypoxia.

Hookah supporters often give in defense of their hobby such an argument: “The smoke has less tar, besides it is filtered through water”. Water really helps to clean the smoke, but do not forget that, unlike cigarettes, hookah – entertainment is far from five minutes. One “filling” hookah can be smoked for an hour, and two, and even more. In addition, the smoking session is often prolonged – the bowl is changed, new tobacco is “scored”, new coals are heated.

Thus, any arguments about the reduced content of harmful substances are completely leveled by the duration of smoking. Moreover, the composition of hookah smoke is largely similar to cigarette smoke. Tars, heavy metals, aldehydes and benzopyrene – all this goes directly from the bowl into the lungs, ignoring the water filter. And given the presence of charcoal, the harm from hookah in many moments is not just comparable to the harm from cigarettes, but exceeds it.

The harm of smoking hookah

Specific consequences of hookah smoking include the development of so-called bronchiectatic disease – purulent inflammation of the respiratory system. Like cigarettes, hookah irritates the respiratory tract and forces it to produce large amounts of mucus – this is the body’s immune response. It also damages the bronchial vesicular epithelium, the tiny hairs that help remove mucus and foreign particles from the airways.

Eventually, chronic inflammation and damage can lead to bronchiectasis – the irreversible enlargement and distortion of the bronchi. In these dilated areas of the bronchi, mucus can build up even more, forming an ideal environment for bacterial infections. The result is a vicious cycle: repeated infections and mucus accumulation exacerbate inflammation, contributing to the progression of bronchiectatic disease.

Paradoxically, the reduced tar content of hookah smoke is not exactly an advantage. No matter how harmful the tars are, due to them the inhaled smoke settles down and does not spread to the deeper parts of the bronchial tree, which already pass into the alveolus. In the case of hookah, the case is different – the smoke is able to damage the alveoli directly.

The body responds by directing fibroblasts – these are connective tissue cells that are able to “patch” the damage, but cannot fulfill the function of the cells they replace. This process gradually worsens gas exchange in the lungs, and it becomes more and more difficult for a person to breathe – connective tissue begins to replace the lung tissue.

Taking into account all of the above, the thesis about the safety of hookah in comparison with cigarettes is at least untenable.