Using a water pipe for smoking is associated with the risk of TB transmission. Transmission of TB is not caused by contact with the waterpipe. TB is spread through the air from one person to other. When the sick person speaks, and especially when he coughs, TB bacteria are released into the air. Waterpipe smoking irritates the lungs and makes the person cough even more. Other people present, can then inhale the TB bacteria in their lungs and get infected.