Do You Inhale Shisha
Do you inhale shisha?
A clear UK 2026 answer with the inhalation technique and health impact. Short answer: yes. Slow deep draws are how hookah is meant to be smoked. Health risks rival or exceed cigarettes.
The short answer
Significant health riskYes. Slow deep draws into lungs.
90,000 ml smoke per 1-hour session vs 500-600 ml per cigarette (CDC). Mouth-only still harmful. Tar 10-200x cigarettes.
90k ml
Smoke per 1-hr session (CDC)
100-200x
More smoke than 1 cigarette
Yes, shisha is meant to be inhaled into the lungs the same way cigarette smoke is. The technique uses slow deep draws (3-5 seconds per pull) rather than the quick short puffs of a cigarette. The smoke passes through water in the hookah base, cools, then travels up the hose, into the mouth and is drawn into the lungs. Per CDC data, a 1-hour shisha session involves inhaling around 90,000 ml of smoke compared to 500-600 ml from a single cigarette - roughly 100-200 times more smoke than a cigarette. Per session a hookah user is exposed to 9 times more carbon monoxide and 1.7 times more nicotine than from one cigarette. Tar is 10-200 times higher concentration than cigarettes; lead 6-10 times higher; formaldehyde 3 times higher. Mouth-only technique (drawing smoke into the mouth and exhaling without lung inhalation) is slightly less harmful but does not eliminate risk because polycyclic aromatic hydrocarbons (PAHs), nitrosamines, heavy metals and oxidants all absorb through the oral mucosa into the bloodstream. Hookah CO poisoning ("hookah sickness") is documented in medical literature with hospital case reports of headache, nausea, lethargy and fainting. Tobacco-free herbal shisha is not safer because the carbon monoxide comes from the burning charcoal rather than the tobacco. Cleveland Clinic position: hookah is just as bad for you as cigarettes.
Shisha exposure in figures
Three CDC and ATS Journal figures every UK shisha user should know.
90kml
Smoke per session
Per CDC data, a typical 1-hour shisha session inhales around 90,000 ml of smoke vs 500-600 ml from a single cigarette.
9x
More carbon monoxide
Per session vs one cigarette. Charcoal heating plus tobacco combustion produces large CO volumes. Cause of "hookah sickness".
10-200x
More tar
Tar concentration in hookah smoke vs cigarette smoke per Annals of the American Thoracic Society review.
Inhalation technique and what it costs
Shisha is meant to be inhaled, the technique differs from cigarettes, and the health implications are significant. Here is the breakdown.
The proper inhalation technique
Hookah inhalation uses slow deep draws, typically 3-5 seconds per pull. The user takes a long pull on the hose, drawing smoke up through the water in the base. The smoke cools as it passes through the water (the main reason the smoke feels smoother than a cigarette). The smoke then enters the mouth and is drawn into the lungs. Some users hold the smoke briefly in the chest before exhaling, similar to cigarette technique. The slow technique is partly cultural (hookah is a social activity meant to last an hour or more) and partly physical (the cooling effect lets users take larger pulls than would be comfortable with hot cigarette smoke).
Why technique matters less than session length
Even users who try to limit lung inhalation end up consuming far more total smoke than a cigarette smoker because sessions are long. A typical hookah session lasts 1 hour vs around 5 minutes for a cigarette. The slow deep draws plus the long session combine to deliver around 90,000 ml of smoke per session per CDC data, compared to 500-600 ml from one cigarette. That is 100-200 times more smoke. The cooling effect of the water masks how much is being consumed; users do not feel the cumulative load until later.
Mouth-only technique still harmful
Some users believe drawing smoke into the mouth and exhaling without lung inhalation is safer. It is not safe. The mouth and throat tissues are absorbent. Several toxins enter the bloodstream via the oral mucosa: nicotine (causes addiction, raises heart rate, raises blood pressure); polycyclic aromatic hydrocarbons (PAHs) (carcinogens linked to oral and lung cancers); nitrosamines (carcinogens); heavy metals (lead, copper, zinc, boron, all toxic and some carcinogenic); oxidants (drive cellular damage). Saliva also traps particulate matter and soluble toxins which get swallowed and absorbed by the gut. Some small particles still reach the lower airways even with strict mouth-only technique. Mouth-only is slightly less harmful than lung-deep inhalation but not safe.
Per-session toxin exposure
Per CDC and Annals of the American Thoracic Society research, a single 1-hour shisha session exposes the user to approximately:
9 times more carbon monoxide than one cigarette. CO binds to haemoglobin and reduces oxygen transport. Cause of hookah sickness (headache, nausea, lethargy, fainting), documented in hospital emergency room case reports. 1.7 times more nicotine than one cigarette. 10-200 times more tar by concentration. Tar is the main carcinogen in tobacco smoke. 10-30 times more carbon monoxide by direct comparison of equivalent volumes. 6-10 times more lead. 3 times more formaldehyde. Plus other heavy metals (copper, zinc, boron) not typically found in cigarette smoke.
Hookah sickness (CO poisoning)
Carbon monoxide poisoning from hookah sessions, sometimes called "hookah sickness", is documented in medical literature with multiple hospital case reports. The mechanism: charcoal burning plus tobacco combustion produces large volumes of CO; CO binds to haemoglobin to form carboxyhaemoglobin, reducing oxygen transport to organs including the brain. Symptoms include headache, nausea, dizziness, lethargy, confusion and fainting. Severe cases require hospital treatment with high-flow oxygen. Risk is highest in long sessions in poorly-ventilated indoor settings (typical hookah lounge conditions). Anyone feeling unwell during or after a hookah session should seek immediate medical attention.
Tobacco-free shisha is not safer
Herbal blends, fruit-pulp shisha and other tobacco-free products are marketed as safer alternatives. The marketing is misleading. Research shows smoke from tobacco-free shisha still contains carbon monoxide and many other toxic agents. The CO comes from the burning charcoal, not the tobacco; CO levels are similar regardless. Polycyclic aromatic hydrocarbons, particulate matter, formaldehyde and other carcinogens are present in tobacco-free shisha smoke. The reduced harm vs traditional shisha is largely limited to nicotine content (reduced but not eliminated in herbal blends). CDC and Cleveland Clinic both warn that herbal shisha should not be considered safe just because it lacks tobacco.
Compared to cigarettes
The Cleveland Clinic position is direct: hookah is just as bad for you as cigarettes. By total smoke volume, one 1-hour hookah session delivers more smoke than a full 20-cigarette pack. By specific toxin: tar 10-200x higher concentration, CO 10-30x higher, lead 6-10x higher, formaldehyde 3x higher. By health outcome: hookah is associated with similar to greater risk of lung cancer, oral cancer, heart disease, gum disease and other chronic conditions compared to cigarette smoking. The cooling effect of water filtration and the social context can mislead users into thinking hookah is gentler. It is not.
For more on shisha and hookah head over to our full vaping guides hub covering related topics including is-shisha-bad-for-you and hookah-vs-shisha terminology.
Four facts every shisha smoker should know
Inhalation is the standard technique
Slow deep draws into the lungs are how shisha is meant to be smoked. Mouth-only is a less common variant.
Mouth-only does not eliminate harm
Carcinogens absorb through oral mucosa, nicotine enters bloodstream via mouth tissues, particles reach lower airways anyway.
Carbon monoxide poisoning is real
"Hookah sickness" is documented in medical literature. Symptoms: headache, nausea, lethargy, fainting. Seek medical attention if affected.
Herbal shisha is not safer
CO comes from burning charcoal, not tobacco. Heavy metals, PAHs and formaldehyde present in herbal blends too.
Shisha vs cigarettes at a glance
A simple comparison of perceived vs actual safety.
Shisha myths
-
✗Water filters out toxins: only cools the smoke.
-
✗Mouth-only is safe: oral mucosa still absorbs.
-
✗Herbal is harmless: charcoal CO unchanged.
-
✗Less than cigarettes: 100-200x more smoke per session.
-
✗Social so it's OK: social context does not change chemistry.
-
✗Smooth so gentle: cooling masks the load.
What the science says
-
✓90,000 ml smoke per session: CDC measurement.
-
✓9x more CO than one cigarette: per session.
-
✓10-200x more tar: by concentration.
-
✓1.7x more nicotine: per session.
-
✓Hookah sickness real: hospital case reports.
-
✓Cleveland Clinic position: as bad as cigarettes.
For more on shisha terminology and health impact head over to our full vaping guides hub where every shisha question is covered in plain English.
Back to the Vape Store Direct guides
This article sits inside our full vaping guides hub. Head back to the index for over 100 plain English answers covering UK vape law, hardware, e-liquid, shisha and everyday questions.
More on shisha and hookah
For terminology our piece on hookah vs shisha covers the word origins. For the broader health question our walkthrough on whether shisha is bad for you covers chronic effects. And our piece on what is shisha covers the basics.
