“If there were ten of us at a party, there would be at least three hookahs.” The sessions would continue until the effects began to show: “I smoked so much that my head was spinning and my blood pressure dropped.”
At 16, entrepreneur Ariane Lima Correia began smoking hookah at parties and gatherings with friends. She didn’t have one at home, but she says someone almost always brought one to gatherings.
“If there were ten of us at a party, there would be at least three hookahs,” he recalls. The sessions continued until the effects of nicotine and smoke began to kick in. “I smoked so much that my head would spin and my blood pressure would drop.”
Over time, e-cigarettes also became part of his habits. Consumption occurred mostly on weekends and was associated with outings with friends, often accompanied by hookah.
“I never smoked at home. But when I went out at night, yes,” she says.
Ariane belongs to a generation that had one of its first contact with tobacco and nicotine in the hookah and that, subsequently, witnessed the rapid spread of e-cigarettes among younger people.
On the occasion of Brazil’s National Day for the Fight Against Smoking, celebrated on August 29, the doctors interviewed emphasized that even apparently “social” consumption, limited to parties or weekends, can cause damage to health.
The first symptoms
Ariane’s health problems began in 2023, when she began experiencing recurring episodes of a dry cough, fever, and back pain on the left side. She took medication and improved, but after some time, the symptoms returned.
In July of that same year, his condition worsened. A spot found on his lung prompted doctors to further investigate and consider several hypotheses, including pneumonia and cancer.
The antibiotics did not produce the expected results and Ariane remained hospitalized for 45 days.
“The doctors said my lung looked like that of a 40-year-old who had smoked all his life,” he says.
Several cavitations, abnormal spaces filled with air or fluid within the lung tissue, had appeared in the lung. Doctors even considered removing part of the left upper lobe.
After this experience, Ariane stopped smoking.
Even occasional smoking carries risks
Even those who smoke only occasionally are not immune to the risks.
Ingrid Higashi, a pulmonologist at the Hospital Estadual de Bauru, in the state of São Paulo, and the One Care network, explains that each episode of exposure to smoke puts the airways and alveoli in contact with irritants and toxins.
In the short term, coughing, phlegm, wheezing, and difficulty breathing may occur. Repeated exposure can lead to a persistent inflammatory process, promoting changes in lung tissue.
In the case of hookah, one of the most common misconceptions is that passing smoke through water eliminates or significantly reduces risks.
Luiz Felipe Natel Kugler Mendes, a pulmonologist at the Hospital Vita in Curitiba, explains that water can lower the temperature of the smoke and partially attenuate the irritating effect on the respiratory tract, but it does not act as a filter capable of eliminating toxic substances.
There’s also coal used to heat tobacco. According to Higashi, its combustion releases carbon monoxide, particulate matter, and other harmful substances.
Carbon monoxide binds to hemoglobin and reduces the blood’s ability to carry oxygen.
Tuberculosis and a new diagnosis
By January 2024, Ariane had resumed her normal work activities, but the dry cough had not disappeared.
The following month, after further deterioration, he returned to the hospital. A CT scan revealed the need to check for tuberculosis, which was later confirmed by sputum tests.
The illness was accompanied by rapid weight loss. Ariane says she lost 10 kilos in a single month and, at one point, 7 kilos in a week.
At the beginning of the therapy she took up to nine tablets a day and says she even lost consciousness.
According to Mendes, tuberculosis can cause cavitations in the lungs. Prolonged exposure to smoking, however, is associated with inflammatory processes that can promote chronic bronchitis and emphysema and, in the long term, contribute to the development of chronic obstructive pulmonary disease (COPD).
The problem returns
Ariane’s problems, however, did not end with the first treatment.
At the end of January 2025, the cough returned, this time accompanied by severe chest and back pain and difficulty breathing.
“I got to the point where I couldn’t even brush my teeth or wash the dishes,” she says.
Since the beginning of his health problems he had lost a total of 18 kilos.
New tests, including some biopsies, have identified the presence of the Mycobacterium avium, a mycobacterium different from the one responsible for tuberculosis.
Ariane then began a new therapy which, she says, should last at least a year and eight months.
Specialists emphasize that the young woman’s medical history does not allow them to establish when and how she came into contact with the microorganisms responsible for the infections.
However, sharing hookah can be one of the situations that can facilitate the transmission of infectious agents.
“Sharing a mouthpiece facilitates the transmission of infections,” explains the pulmonologist.
Among the possible agents he mentions viruses such as influenza and coronavirus, herpes and bacteria responsible for oral infections.
“There are also documented cases of tuberculosis transmission. If a person is actually infected and shares a device, other people who smoke with them can also be exposed to this type of infection.”
The risk, however, is not limited to direct contact with the mouthpiece.
According to Mendes, liquids and residues that accumulate inside the appliance, especially when it is not cleaned properly, can encourage the proliferation of microorganisms.
“Stagnant water can become a breeding ground and promote the transmission of infections,” he warns.
This, however, It does not mean that the tuberculosis or Mycobacterium avium infection contracted by Ariane was caused by hookah..
In addition to possible transmission through device sharing, smoking itself can make the respiratory system more vulnerable.
People who smoke, explains Mendes, have a higher incidence of respiratory infections due to the damage caused by continuous exposure to smoke.
The spread of electronic cigarettes
Ariane started smoking at a time when hookah was still very popular among friends. Among young people, however, that space has gradually been taken over by e-cigarettes.
Jaqueline Scholz, a cardiologist and director of the InCor-HCFMUSP Smoking Cessation Program, says that in the past she mostly saw adult smokers of traditional cigarettes.
Today, however, he observes an increasing number of nicotine consumers among young people.
The way we consume has also changed.
According to Scholz, smoking a pack of traditional cigarettes is equivalent to about 250 puffs, while a frequent user of electronic cigarettes can get to about 1,000 shots per day.
And the device doesn’t just produce “water vapor.”
Higashi explains that e-cigarettes heat a liquid, turning it into an aerosol that may contain nicotine, ultrafine particles, metals, and volatile organic compounds, as well as substances formed during heating, such as formaldehyde and acrolein.
Among the complications already described is the EVALI, an English acronym for “lung injury associated with the use of electronic cigarettes or vaping products”.
The condition can cause coughing and difficulty breathing and, in severe cases, can lead to respiratory failure.
According to Scholz, e-cigarettes have exacerbated the problem because they allow for practically continuous consumption.
The cardiologist says she sees young patients who already show signs of addiction, including anxiety when they stop smoking and heart rate changes associated with consumption.
“I spend more time in the hospital than at home.”
Today Ariane is 26 years old and says she has no intention of going back to smoking hookah or e-cigarettes.
His life, however, continues to be marked by therapies.
Every Monday, Wednesday, and Friday, he goes to a UBS, Brazil’s Basic Public Health Unit, to receive medications through a catheter.
Once a week he also returns to the Hospital das Clínicas in São Paulo for check-ups, tests, and device maintenance.
“I usually say I spend more time in the hospital than at home,” she says.
The consequences are also felt in everyday life.
The entrepreneur, who once loved playing footvolley, now suffers from severe shortness of breath. She continues to go to the gym, but avoids lifting weights and prefers to use machines.
Also try to avoid crowded environments and reduce exposure to respiratory infections as much as possible.
Married and the mother of a young daughter, she now looks differently at people who smoke in bars and at social gatherings.
What began in adolescence, almost as a natural part of parties and nights out with friends, has left consequences that are still part of his life today.
“My life has changed completely. My message to people is to stop while there’s still time. All of this can lead to death much faster than we imagine.”