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Background: The prevalence of water pipe (WP) smoking was studied using a standard questionnaire. Pulmonary function tests were also compared between WP smokers and non-smokers. Materials and Methods: The prevalence of WP smoking was studied using a standard questionnaire. Pulmonary function tests including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF), maximal expiratory flow at 75%, 50%, and 25% of the FVC (MEF75,50,25) were compared between WP smokers and non-smokers. Results: A total of 673 individuals including 372 males and 301 females were interviewed. The number of WP smokers was 58 (8.6%) including 24 males (6.5%) and 34 females (11.3%). All pulmonary functional test (PFT) values in WP smokers were lower as compared to the non-smokers (P < 0.05 to P < 0.001). The prevalence and severity of respiratory symptoms (RS) in WP smokers were higher than non-smokers (P < 0.05 to P < 0.001). There were negative correlations between PFT values and positive correlation between RS and duration, rate, as well as total smoking (duration X rate) (P < 0.05 to P < 0.001). Conclusion: In this study the prevalence of WP smoking in Mashhad city was evaluated for the first time. The results also showed a significant effect of WP smoking on PFT values and respiratory symptoms. [ABSTRACT FROM AUTHOR]