Increasing Trend and Poor Outcomes Associated With Cannabis Use in Young Asthmatics

Abstract

Cannabis use is on the rise due to popularity, legalization and increase in medical use. Cannabis is primarily inhaled as smoke and acts as an instigator for respiratory symptoms especially in patients with Asthma. There are no population-based studies available to estimate the burden and outcomes of cannabis use during asthma hospitalizations. We aim to estimate the trends and characteristics associated with cannabis use among asthma patients. METHODS:Study cohort is derived from the Nationwide Inpatient Sample (NIS) for the years 2008-2017. Hospitalizations due to asthma were identified using previously validated ICD-9-CM/ICD-10-CM. We excluded pregnant patients and restricted our cohort to the younger age group of 18-49 years for final analysis. Cannabis use disorder and other diagnosis of interests were identified by ICD-9/10-CM codes. We then utilized the Cochran Armitage trend test and multivariable survey logistic regression models to analyze temporal trends, predictors and outcomes.RESULTS: Out of a total 1,014,328 hospitalizations due to Asthma in young adult patients, 36,008 (3.6%) had concurrent cannabis use disorder. Proportion of patients using cannabis increased from 1.8% in 2007 to 7.5% in 2018 with a yearly increase of 14.9% (OR 1.2; 95%CI 1.1-1.2; p<0.01). Patients with concurrent cannabis use were younger and more likely to be male and African American. In multivariable regression analysis, age group 18-34 (OR 1.9; 95%CI 1.5-2.0; P< 0.01); females (OR 2.1; 95% CI 2.0-2.3; p<0.01), African American (OR 1.8; 95%CI 1.6 -1.9, p<0.01), lowest income status (OR 1.3; 95%CI 1.2-1.4, p<0.01), west region (OR 1.6; 95% CI 1.4-1.7, p<0.01), mid-west, uninsured/self-pay (OR 1.1 ;95% CI 1.1-1.2, P¼0.006) and conditions such as weight loss (OR 1.8; 95% CI 1.4-2.2, p<0.01), alcoholism (OR 3.8; p <0.01) and cancer were associated with higher odds of concurrent cannabis use. After adjusting with confounding factors cannabis use was not associated with inhospital mortality or discharge to facilities. However, cannabis use was associated with higher odds of non-invasive ventilation (OR 1.3; 95% CI 1.2-1.5, p<0.01) and invasive ventilation (OR 1.4; p<0.01).CONCLUSIONS: Cannabis use is more prevalent in younger, male gender, African American and lower socio-economic asthmatic patients. Although concurrent cannabis use disorders are not associated with increased in-hospital mortality or discharge to facilities, it is associated with increased ventilation utilization rates.CLINICAL IMPLICATIONS: Our study identifies the determinants among the cannabis usage in Asthma patients depicting the increasing trend and requirement of ventilation among the hospitalizations. Ultimately, additional research and guidelines are needed to curtail the cannabis use in asthmatic patients.