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[19] During the early stages, a combination of perceived pleasure acting as positive reinforcement and desire to respond to social peer pressure may offset the unpleasant symptoms of initial use, which typically include nausea and coughing

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Most people with COPD have both of these conditions, but how severe they are varies from person to person

In comparison to cigarettes, hookah puffing is more variable including total puffing time, number of puffs, and total smoke inhaled, all being affected by the nicotine content of tobacco, the presence of flavors, the personal preferences, and the social setting of the vaping session [12, 15, 16]