Hookah consumption is harmful to human health and can cause various diseases. Developing lung cancer and other lung diseases are one of the health consequences of hookah consumption. Measuring the perceived risk for being diagnosed with these conditions among hookah users is necessary. Therefore, this study was conducted to determine the perceived risk of lung cancer and Chronic Obstructive Pulmonary Disease (COPD) in hookah users in Iran. This cross-sectional study was conducted with a descriptive-analytical approach on 340 hookah users between January-May 2023. These people were recruited through convenience sampling. The information on the perceived risk of participants was collected through a questionnaire on the perceived risk of lung cancer and COPD. Data were analyzed through descriptive tests and multiple linear regression tests. These analyses were performed using Stata statistical software version 17. The mean and standard deviation of the perceived risk for lung cancer was 8.41 ± 5.50 and for COPD was 8.51 ± 5.58 out of 20 possible scores. The results of multiple linear regression generally showed that the using other type of tobacco (β = 3.14, p < 0.0001), 2 or more use of hookah in past month (β=-3.41, p = 0.025), unskilled workers (β = 1.79, p = 0.017), married smokers (β=-1.31, p = 0.026), negative attitude toward hookah (β = 0.46, p < 0.0001) were the predictive variables regarding to lung cancer perceived risk. In line with COPD the using other type of tobacco (β = 3.47, p < 0.0001), once a month use of hookah in past month(β=-3.74, p = 0.041) and twice or more use of hookah in past month (β=-4.82, p = 0.008), smokers in contemplation stage (β = 3.91, p < 0.0001), female smokers (β = 3.08, p < 0.0001), unskilled workers (β = 2.42, p = 0.007), negative attitude toward hookah (β = 0.46, p < 0.0001) were the predictive variables to COPD perceived risk. In general, the perceived risk of developing lung cancer and COPD among hookah users was low. Therefore, it is necessary to provide widespread information about the potential harm of hookah in causing lung cancer and COPD, at the community level.