Effect of cannabis and tobacco on emphysema in patients with spontaneous pneumothorax

Ruppert, Anne-Marie; Perrin, James M.; Khalil, Antoine; Vieira, Thiago da Silva; Abou-Chedid, D.; Masmoudi, Hicham; Créquit, Perrine; Giol, M.; Cadranel, Jacques; Assouad, Jalal; Gounant, V.

doi:10.1016/j.diii.2018.01.017

Cited by 22 publications

(13 citation statements)

References 17 publications

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“…This is in contrast to a case series of 10 patients which found asymmetrical bullous changes on CT among chronic marijuana smokers but with normal spirometry and chest radiographs [37]. A study looking at smoking status and the presence of emphysematous computed tomography changes of spontaneous pneumothorax patients found no difference in emphysema prevalence among tobacco smokers and tobacco plus cannabis smokers (there were no cannabis only smokers); however, concurrent smokers were significantly younger [49]. While the authors have suggested that cannabis added to tobacco leads to emphysema at a younger age, there are too many confounders such as the subject population, to come to a definitive conclusion.…”

Section: Bullous Lung Diseasementioning

confidence: 60%

Marijuana and the lung: hysteria or cause for concern?

Ribeiro

Ind

2018

Breathe

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Increasing cannabis use and legalisation highlights the paucity of data we have on the safety of cannabis smoking for respiratory health. Unfortunately, concurrent use of tobacco among marijuana smokers makes it difficult to untangle individual effect of marijuana smoking. Chronic cannabis only smoking has been shown in large cohort studies to reduce forced expiratory volume in 1 s/forced vital capacity via increasing forced vital capacity in chronic use contrary to the picture seen in tobacco smoking. The cause of this is unclear and there are various proposed mechanisms including respiratory muscle training secondary to method of inhalation and acute anti-inflammatory effect and bronchodilation of cannabis on the airways. While cannabis smoke has been shown to increase symptoms of chronic bronchitis, it has not been definitively shown to be associated with shortness of breath or irreversible airway changes. The evidence surrounding the development of lung cancer is less clear; however, preliminary evidence does not suggest association. Bullous lung disease associated with marijuana use has long been observed in clinical practice but published evidence is limited to a total of 57 published cases and only one cross-sectional study looking at radiological changes among chronic users which did not report any increase in macroscopic emphysema. More studies are required to elucidate these missing points to further guide risk stratification, clinical diagnosis and management.Key pointsCannabis smoking has increased and is likely to increase further with relaxation of legalisation and medicinal use of cannabinoids.Chronic marijuana smoking often produces symptoms similar to those of chronic tobacco smoking such as cough, sputum production, shortness of breath and wheeze.Cessation of marijuana smoking is associated with a reduction in respiratory symptoms and no increased risk of chronic bronchitis.Spirometry changes seen in chronic marijuana smokers appear to differ from those in chronic tobacco smokers. In chronic marijuana smokers there is an increase in FVC as opposed to a definite decrease in FEV1.Multiple case series have demonstrated peripheral bullae in marijuana smokers, but no observational studies have elucidated the risk.There is currently no clear association between cannabis smoking and lung cancer, although the research is currently limited.Educational aimsTo update readers on legalisation of recreational and medicinal cannabis.To summarise the evidence base surrounding the respiratory effects of inhaled marijuana use.To provide clinicians with an understanding of the main differences between cannabis and tobacco to be able to apply this to patient education.To highlight common respiratory problems among cannabis users and the need for recreational drug history taking.

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Section: Bullous Lung Diseasementioning

confidence: 60%

Marijuana and the lung: hysteria or cause for concern?

Ribeiro

Ind

2018

Breathe

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“…[9] and Ruppert and coll. [19] reported 102, 153 and 83 patients respectively who presented with spontaneous pneumothorax, of whom 17 (17%), 13 (8%) and 32 (38%) respectively smoked cannabis. In these studies CaS showed an higher incidence of lung bullae detected by CT-scan with respect to cannabis nonsmokers (tobacco smokers or nonsmokers).…”

Section: Plos Onementioning

confidence: 99%

Secondary spontaneous pneumothorax and bullous lung disease in cannabis and tobacco smokers: A case-control study

et al. 2020

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Background The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients. Methods and findings We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/ years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related. Conclusions Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous

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“…Our patient with a history of heavy marijuana and tobacco smoking presented initially with a spontaneous pneumothorax that was drained via thoracosto-taneous pneumothorax. A retrospective cohort study by Ruppert, et al found that patients with a history of tobacco smoking were more likely to presentation with spontaneous pneumothorax at a much older age than those with a history of tobacco and cannabis smoking [7].…”

Section: Clinical Presentationmentioning

confidence: 99%

Recurrent Spontaneous Pneumothorax Secondary to Marijuana-Induced Extensive Bullous Emphysema

Aboulenain¹,

Dewaswala²,

Huzefa³

et al. 2020

Int J Respir Pulm Med

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Marijuana is the world's most commonly used illicit drug. Its use is estimated to be around 2% to 5% of the worldwide population and the most commonly used route of use is inhalation. Although not completely elucidated, marijuana has been linked with lung damage and bullous formation. We report a case of a young man with a significant history of marijuana smoking who presented with a recurrent large spontaneous pneumothorax refractory to non-surgical management. CASe RepoRt Check for updates any physical trauma. His past medical history is significant for a pneumothorax that has resolved three-month ago. Past surgical history and family history were unremarkable. Social history was significant for daily marijuana and tobacco smoking.

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Effect of cannabis and tobacco on emphysema in patients with spontaneous pneumothorax

Abstract: The prevalence of emphysema visible on CT is not different between tobacco and tobacco/cannabis smokers, however, it occurs at a younger age in tobacco and cannabis smokers. This result suggests that cannabis, when added to tobacco, may lead to emphysema at a younger age.

Cited by 22 publications

References 17 publications

Marijuana and the lung: hysteria or cause for concern?

Marijuana and the lung: hysteria or cause for concern?

Secondary spontaneous pneumothorax and bullous lung disease in cannabis and tobacco smokers: A case-control study

Recurrent Spontaneous Pneumothorax Secondary to Marijuana-Induced Extensive Bullous Emphysema

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