Background and objective:  A major type of smoking in Middle Eastern countries is water pipe (WP) smoking. In the present study, pulmonary function tests (PFT) and respiratory symptoms (RS) were compared in WP smokers and deep inspiration (S‐DI) or normal inspiration (S‐NI) cigarette smokers.

Methods:  Pulmonary function and RS were compared among WP smokers, deep or normal inspiration cigarette smokers, and non‐smokers.

Results:  All PFT values in WP smokers and S‐DI, but only some values in S‐NI, were lower than those of non‐smokers (P < 0.05 to P < 0.001). In addition, all PFT values in WP smokers and S‐DI were lower than the corresponding values in S‐NI, except for forced expiratory volume in 1 s and maximal expiratory flow at 25% of forced vital capacity (P < 0.05 to P < 0.001). The prevalence of RS, except for sputum production, was greater in all three groups of smokers than in non‐smokers (P < 0.05 to P < 0.001). However, the severity of most RS in WP smokers and S‐DI, but only the severity of wheezing in S‐NI, was greater than that in non‐smokers (P < 0.05 to P < 0.01). There were inverse correlations for PFT values and positive correlations for RS, with duration and total amount of smoking (P < 0.05 to P < 0.001).

Conclusions:  The results from this study showed that there was a profound effect of WP smoking on PFT values and RS, which were similar to the effects of deep inspiration cigarette smoking.