Smoking a Chinese Water Pipe Is Worse than Cigarette Smoking

Smoking a Chinese Water Pipe is Not Safe – Increased Risk of COPD Smoking tobacco through a water pipe is a popular activity in China, Burma, Laos, and Vietnam. Based on tradition, it has been thought that using a Chinese water pipe is safer than smoking a cigarette because tobacco smoke is filtered by the water. The Chinese water pipe has a cigarette holder along with a long and wide stem which holds the water.


This study published in the October 2014 issue of CHEST (volume 146; pages 924 – 931) surveyed 1,238 adults at least 40 years of age living in 10 towns in the Yunnan Province of China. In these areas, nearly all people who smoke a Chinese water pipe are men who usually smoke at home while the wife is exposed to passive smoking. For purposes of the study, both Chinese water pipe and cigarette smoking were defined as smoking at least 400 cigarettes per year for at least one year. The authors also analyzed the water used in the water pipes.
Man smoking a Chinese water pipe

Man in China smoking a water pipe


Both the Chinese water-pipe smokers and the cigarette smokers reported their habit for an average of 28 years. The risks (called odds ratio) of having COPD were: RISK of COPD 10.6 – Chinese water-pipe smokers – 56% had COPD 5.5 – Passive Chinese water-pipe smokers – 39% had COPD 3.2 – Cigarette smokers – 34% had COPD 2.5 – Passive cigarette smokers – 28% had COPD Another risk factor for COPD in all groups was poor ventilation from stoves with chimneys. The authors reported that the water was generally “dirty” and was changed on average every 3 days by self-report. Total organic carbon of the water-pipe was 47 – 100 times greater than found in standard drinking water. Particulate matter 2.5 (microscopic solid or liquid matter suspended in the air which is commonly called air pollution) from the Chinese water pipe was twice as high as from cigarette smoke. In summary, the study concluded that the damage to the lungs from Chinese water pipe use and exposure is worse than that from smoking cigarettes.

My Comments

This study in China shows that although water pipe smoking has traditionally been thought to safe, it is not! If you or your loved one has COPD, it is important to AVOID inhaling any irritant in the air that we breathe, such as smoke, dust, fumes, and fibers.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.