An investigation into adult water-pipe tobacco smokers in Kano, Nigeria, has demonstrated significant associations between self-reported respiratory symptoms and measurable variations in spirometric lung function parameters. The cross-sectional study, conducted among patrons of dedicated smoking venues, identified that chronic respiratory complaints—most notably exertional dyspnea, recurrent wheezing, and frequent phlegm production—were widely prevalent across the cohort. Inferential statistical evaluation using Spearman rank correlation confirmed that several of these clinical manifestations were correlated with both forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), highlighting pulmonary impairment among water-pipe users who frequently perceive the practice as a benign alternative to combustible cigarettes.
The study population comprised 135 adult Shisha smokers who met strict eligibility criteria out of an initial sample of 270 individuals recruited via simple random sampling across commercial smoking joints in the Nassarawa Local Government Area of Kano State. The demographic profile showed that 111 participants (82.2 percent) were male and 24 (17.8 percent) were female. Furthermore, 134 respondents (99.3 percent) were unmarried, with only one participant (0.7 percent) reporting married status, while 99 individuals (71.1 percent) had attained higher education. To prevent confounding from alternative tobacco exposures, researchers deliberately excluded individuals who engaged in any concurrent forms of tobacco consumption, such as standard commercial cigarettes.
Data collection relied on standardized clinical questionnaires and physiological diagnostic equipment administered after securing ethical approval from the Research and Ethics Committee of the Kano State Ministry of Health and introductory clearance from the Department of Physiotherapy. Respiratory symptoms were systematically captured using the American Thoracic Society Division of Lung Diseases (ATS-DLD-78) questionnaire. Pulmonary function was measured using an MSO4 portable spirometer to determine key ventilatory volumes. In addition, physical and cardiovascular baseline characteristics were recorded using a mercury sphygmomanometer and stethoscope for blood pressure, a pulse oximeter for arterial oxygen saturation, and a stadiometer for precise height and weight measurements.
Evaluation of symptom frequencies from the ATS-DLD-78 instrument established a substantial burden of chronic respiratory distress among the enrolled participants. Exertional breathlessness was the single most common complaint, with 60 participants (44.4 percent) experiencing shortness of breath when walking up a slight hill or hurrying on level ground, 41 participants (30.4 percent) walking slower than contemporaries due to breathlessness, and 12 participants (9.8 percent) needing to stop for breath when walking at an ordinary pace on level ground. Phlegm production was also prominent, reported by 48 participants (35.6 percent) upon their first smoke and by 52 participants (38.5 percent) at least twice daily for four or more days per week. Coughing episodes affected 43 smokers (31.9 percent) with their first smoke, 24 smokers (17.8 percent) between four and six times daily, and 21 smokers (15.6 percent) upon waking in the morning. Wheezing in the chest was recorded in 42 participants (31.1 percent) during colds, in 36 participants (26.7 percent) occasionally apart from colds, and in 17 participants (12.6 percent) on most days or nights.
Spearman rank correlation analyses revealed distinct patterns of association between individual respiratory complaints and FEV1 measurements. A statistically significant moderate positive correlation emerged between occasionally wheezing apart from cold and FEV1 (r = 0.383; p = 0.000). Weak positive correlations were noted between FEV1 and periods of increased cough and phlegm lasting three weeks or more in a year (r = 0.229; p = 0.008), as well as walking slower than peers due to breathlessness (r = 0.175; p = 0.042). Conversely, statistically significant inverse relationships were documented between FEV1 and producing phlegm during chest illnesses (r = -0.217; p = 0.012), having experienced any chest illness within the preceding three years (r = -0.183; p = 0.034), history of hay fever (r = -0.222; p = 0.010), and diagnosed pneumonia or bronchopneumonia (r = -0.177; p = 0.040). Reported attacks of wheezing showed a weak negative trend with FEV1 (r = -0.150; p = 0.083), while self-reported emphysema exhibited a weak positive association (r = 0.165; p = 0.055).
Specific water-pipe consumption patterns also correlated with measured pulmonary volumes. Inhaling pipe smoke showed a statistically significant weak positive correlation with both FEV1 (r = 0.290; p = 0.001) and FVC (r = 0.184; p = 0.033). Regular pipe smoking was likewise positively correlated with FVC (r = 0.171; p = 0.048) and showed a marginal correlation with FEV1 (r = 0.155; p = 0.072). In contrast, the chronological age at which an individual began smoking a pipe regularly displayed a significant inverse correlation with FEV1 (r = -0.312; p = 0.000) and a negative trend with FVC (r = -0.149; p = 0.085). Furthermore, total weekly time dedicated to smoking pipe tobacco was inversely correlated with FEV1 performance (r = -0.187; p = 0.030), confirming that intensity and timing of water-pipe exposure are tied to ventilatory metrics.
Correlation patterns between reported symptoms and FVC values further elucidated the pulmonary impact across the cohort. Statistically significant negative associations with FVC were identified for cough accompanied by the first smoke (r = -0.180; p = 0.037), chest wheezing or whistling during cold episodes (r = -0.207; p = 0.016), acute wheezing attacks (r = -0.227; p = 0.008), having two or more wheezing episodes (r = -0.182; p = 0.035), taking medication or clinical treatment for chest symptoms (r = -0.200; p = 0.020), and producing phlegm during chest illnesses (r = -0.172; p = 0.045). In contrast, positive associations with FVC were documented for occasional wheezing apart from cold (r = 0.299; p = 0.000), breathlessness (r = 0.191; p = 0.026), walking slower than peers (r = 0.190; p = 0.027), stopping for breath when walking (r = 0.192; p = 0.027), and self-reported emphysema (r = 0.165; p = 0.055).
Contextualizing their findings within global and national tobacco trends, the authors noted that water-pipe smoking has expanded substantially despite customary origins in the Middle East, Southeast Asia, and North Africa. Epidemiological data reviewed in the paper indicate that adult smoking prevalence in northeastern Nigeria has reached up to 31.9 percent, markedly exceeding older national survey figures of 8.6 percent from 2002 and southwest rural rates of 17.6 percent. This widespread adoption is heavily propelled by the popular misconception that bubbling tobacco smoke through water neutralizes harmful toxins, as well as the appealing addition of honey and fruit flavorings. Laboratory evidence cited in the study demonstrates that water-pipe smoke contains hazardous concentrations of carbon monoxide, nicotine, tar, and heavy metals that match or exceed cigarette smoke, with a single one-hour water-pipe session releasing sidestream toxicants equivalent to smoking 2 to 10 combustible cigarettes.
The observed clinical profile aligns with published international literature cited by the investigators examining water-pipe toxicity. Prior research by Al-fayez and colleagues reported significant decrements in FVC relative to FEV1 among male water-pipe users alongside progressive pulmonary decline linked to user age. Similarly, systematic meta-analyses conducted by Raad and colleagues established that water-pipe users experience marked reductions in FEV1, FVC, and the FEV1/FVC ratio compared to non-smokers, while Boskabady and collaborators demonstrated substantial deficits across broad spirometric parameters including mid-expiratory flow rates. The authors highlighted that their cohort exhibited measurable impairment consistent with obstructive airway patterns, accompanied by cardiovascular observations featuring elevated systolic and diastolic blood pressure levels alongside slight depressions in blood oxygen saturation.
In their concluding synthesis, the authors emphasized that recurrent wheezing attacks, exertional breathlessness, persistent phlegm, and earlier initiation ages represent tangible markers of lung function vulnerability among Shisha users in Kano. Given the ongoing absence of local public health campaigns in Kano State, the investigators called for immediate policy measures, including increased duties and sales taxes on water-pipe tobacco products, strict enforcement of statutory smoking bans, and comprehensive awareness campaigns aligned with observances such as World Tobacco Day and World Health Day. They also recommended that subsequent investigations incorporate additional physiological indices, including respiratory rate and chest expansion, to expand upon the respiratory and cardiovascular evidence base.
Subject of Research: Association between respiratory symptoms and spirometric lung function among adult Shisha smokers in Kano, Nigeria
Article Title: Association between respiratory symptoms and lung function among Shisha smokers in Kano, Nigeria
Article References: sumaila, F. G., Shittu, A., Fagge, A. L., Bappah, B. S., & Umar, L. (2025). Association between respiratory symptoms and lung function among Shisha smokers in Kano, Nigeria. Bulletin of Faculty of Physical Therapy, 30(1), Article 72. https://doi.org/10.1186/s43161-025-00334-7
Image Credits: AI Generated
DOI: 10.1186/s43161-025-00334-7
Keywords: Shisha smoking, water-pipe tobacco, FEV1, FVC, spirometry, respiratory symptoms, Kano State, ATS-DLD-78, pulmonary function, wheezing, phlegm production, shortness of breath, obstructive airway disease, tobacco control, Nassarawa LGA, environmental tobacco smoke
