Despite shisha being a familiar part of evening leisure for many people, often accompanied by socializing, coffee, and long periods at the table, doctors caution that this habit should not be considered a safer or less harmful alternative to smoking.
Dr. Mohammed Fawzi Katranji, a pulmonologist from Dr. Sulaiman Al Khabeeb Medical Group, stated that a one-hour shisha session can be comparable to smoking about 40 cigarettes. He emphasized that many users do not consider themselves smokers at all.
Speaking at the conference 'Quit Like Sweden: The Swedish Experience,' Dr. Katranji noted that this is one of the most serious issues doctors face when discussing tobacco consumption with patients. He mentioned that during anamnesis, people often answer negatively to questions about smoking but later admit to using shisha once or twice a week, or even twice in one day.
According to Dr. Katranji, the belief that shisha is safer because the smoke passes through water lacks scientific basis. Users of shisha, hookah, midawah, or dukhah can be exposed to the same dangers associated with combustible tobacco, including tar, carbon monoxide, and other harmful substances.
He called for more in-depth local studies comparing the long-term risks associated with cigarettes, shisha, midawah, and vaping, as one cannot rely solely on a patient's answer to a single question about smoking.
Dr. Rachel Kaminski, a consultant pulmonologist at Saudi German Hospital, believes that medical teams are obliged to ascertain exactly what patients use, how often, and under what conditions. She added that this list should include cigarettes, shisha, midwahs, vapes, and other nicotine-containing products.
In her words, the question of what, how, and when a patient smokes is extremely important in pulmonary clinics. Dr. Kaminski also specified that under standard use, people can smoke shisha for two to four hours, which, according to her calculations, is equivalent to smoking up to 200 cigarettes.
Doctors also pointed out that many smokers become accustomed to symptoms such as daily cough, wheezing, phlegm, and shortness of breath, considering them simply part of the smoking process rather than signs requiring medical attention. This can lead to delayed diagnosis of Chronic Obstructive Pulmonary Disease (COPD)—a progressive lung disease that makes breathing difficult.
Dr. Kaminski explained that with COPD, air can become trapped in the lungs, making ordinary activities such as climbing stairs, working, or taking children to school significantly harder. Specialists stressed that the main goal must always be to help people quit smoking completely. Patients who cannot quit require realistic, non-judgmental support, including counseling, medication if necessary, and regular monitoring.
She strongly recommended integrating smoking cessation support into primary healthcare, pulmonology clinics, and cardiology services, instead of leaving patients to seek help independently. The main message of the conference was clear: shisha is smoking, and persistent coughing, wheezing, or shortness of breath should not be ignored as a mere characteristic of the habit.