Objective: Water pipe smoking WPS (Shisha) is becoming increasingly acceptable in the youth and is contributing to the burden of respiratory diseases. The aim of this study was to assess the frequency of early respiratory symptoms in relation to the severity and duration of WPS smoking in the medical students of Karachi. Methods: This cross-sectional study was conducted in medical colleges of Karachi. A self-administered questionnaire collected information about smoking habits and respiratory symptoms from students.   Results: Out of 250 participants, 68.8 % (n=172) were short term smokers. 31.6% (n=79) reported to have smoked shisha monthly. The main reason of smoking shisha for 26% (n=65) was just to fill in the free time with friends. 39.4% (n=88) intend to quit shisha smoking in future. 32.4% (n=81) of the students experienced shortness of breath, 30.4% (n=76) Dry cough, 30.4% (n=76) Scratchy sensation in the throat, 23.6% (n=59) rapid breathing, 20% (n=50) chest tightness and 13.6% (n=34) hoarse voice after shisha consumption. The association of these symptoms with duration and severity of shisha exposure remained insignificant.  Conclusion: The results of this study show that smoking shisha can bring about the early respiratory symptoms. Education is important in creating awareness about WPS hazards. Key words: Water-pipe; Shisha; Smoking; Medical students; Respiratory symptoms