For many people, shisha is a familiar part of an evening out. It comes with conversation, coffee and long hours at a table. But doctors have warned that the habit should not be seen as a safer or lighter version of smoking.
An hour-long shisha session can be like smoking 40 cigarettes, Dr Mohammed Fawzi Katranji, a pulmonologist at Dr Sulaiman Al Habib Medical Group said, warning that many users do not consider themselves smokers at all.
Speaking at 'Quit Like Sweden: The Swedish Experience' conference, Dr Katranji said this is one of the biggest challenges doctors face when discussing tobacco use with patients.
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“When we take a history, we ask, ‘Do you smoke?’ and they say, ‘No, I don’t smoke,’” he said. “Then you ask a few more questions and they say they smoke shisha once or twice a week, sometimes twice in the same day.”
Dr Katranji said the belief that shisha is safer because the smoke passes through water has no scientific basis. Shisha, hookah and midwakh or Dokha users may also be exposed to the same dangers linked to combustible tobacco, including tar, carbon monoxide and other harmful substances.
Dr Katranji said there is a need for better local research comparing the long-term risks of cigarettes, shisha, midwakh and vaping. "We cannot rely only on a patient’s answer to one question about whether they smoke."
Dr Rachael Kaminski, consultant respiratory physician at Saudi German Hospital said that medical teams must ask what patients use, how often they use it and in what setting. "This should include cigarettes, shisha, midwakh, vapes and other nicotine products," she said.
“Asking what a patient smokes, how they smoke and when they smoke is a very important question in a respiratory clinic,” she said.
Dr Kaminski also mentioned that, on a usual setting, people who order a shisha, smoke for about two to four hours. "By this calculation, a shisha would be equivalent smoking up to 200 cigarettes," said Kaminski.
Dr Kaminski said many smokers normalise symptoms such as a daily cough, wheezing, phlegm and breathlessness. Some may believe these problems are simply part of smoking, rather than signs that they need medical help.
"This can delay the diagnosis of chronic obstructive pulmonary disease, or COPD, a progressive lung condition that makes it difficult to breathe. Air can become trapped in the lungs, making ordinary tasks such as climbing stairs, going to work or taking children to school much harder," said Dr Kaminski.
Doctors also highlighted that the goal should always be to help people stop smoking completely. "People who are unable to quit need realistic, non-judgmental support, including counselling, medication where suitable and regular follow-up," said Dr Kaminski.
She called for cessation support to be built into primary care, respiratory clinics and heart care, rather than leaving patients to find help on their own.
The message from the conference was simple: shisha is smoking. And a persistent cough, wheeze or breathlessness should not be dismissed as just part of the habit.