The medical consequences of narghile (hookah, shisha) use in the world

Background. - Hookah (narghile, shisha) smoking is growing worldwide and particularly in France. The main reasons for this are: first, the arrival on the market of new highly, flavored tobacco-based mixtures; second, a new type of charcoal used as a quick heating source; third, the pleasure to experiment with an exotic orientalist practice or the desire to return to the corresponding tradition; fourth, the belief that water filtration would lower the risk of smoking. Methods and results. - Long-term epidemiological data on complications are scarce. Little is known about qualitative and quantitative transformations occurring when hookah is smoked (in particular regarding carcinogenic agents). Such information will be difficult to collect due to the lack of standardization for this mode of tobacco use. The only current consensus on this issue is that a significant amount of carbon monoxide is produced by the charcoal used to heat and distil the tobacco-molasses mixture. Apart from direct inhalation, concentrations measured in some fashionable hookah lounges and bars are particularly high. Moreover, the additives contained in the widely used quick-lighting charcoals and their harmlessness remain unknown. Conclusion. - This study sets out the available scientific knowledge regarding the real medical consequences related to the growing use of hookah and focuses on the best known and urgent issue, i.e. concern related to carbon monoxide intoxication in a very peculiar context. (C) 2007 Elsevier Masson SAS. All rights reserved.