Background: According to World Health Organization report, chronic obstructive pulmonary disease (COPD) is the fourth cause of death which is increasing, and in the year 2015 it will be responsible for 10% of all deaths globally. Most of current researches focus on cigarette, and its association with diseases such as COPD, while many people in developing countries, including Asia, smoke tobacco using waterpipes. Methods: A total of 245 sex -and age- matched waterpipe smokers for at least 15 years, and 245 nonsmokers, were randomly selected in Bushehr, and Tangestan districts of Bushehr Province. Salbutamol spray was used for assessing the airways reversibility. Spirometry was done three times for all subjects using a portable spirometer. Results: The prevalence of COPD among waterpipe smokers was 10.2% and none of the nonsmokers had COPD (P<0.001). A total of 66.6% of the cases had severe to very severe airway obstruction. Sex (male), age, smoking period, daily waterpipe runs, and job had significant correlations with COPD. Clinical symptoms such as dyspnea, cough, sputum, and cough and sputum for more than 2 years, were higher in subjects with COPD. COPD prevalence was 2.84 times higher in farmers and construction workers (95% CI: 1.06-7.63). Conclusion: Chronic obstructive pulmonary disease is extremely high in waterpipe smokers. Thus, its risk for COPD should be considered as cigarette.

Keywords: chronic obstructive pulmonary disease, waterpipe, cigarette, spirometry, cough

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