CHEST
CommentaryAhead of the CurveCannabis Smoking in 2015: A Concern for Lung Health?
Section snippets
Biology of the Cannabis Plant
To understand the potential clinical impact of inhaled cannabis use on lung health, it is important to appreciate the plant's complexity and mechanisms of action.5 Cannabis contains 483 unique compounds, including 66 cannabinoids. Ten subclasses of cannabinoids have been characterized, including Δ-9-tetrahydrocannabinols (THCs) and seven subclasses of cannabidiols (CBDs).6 THCs are the primary psychoactive substances, with pharmacologic properties including euphoria and analgesia. In contrast,
Epidemiologic Investigations Related to Cannabis and Lung Health
The focus of epidemiologic data published in the past 15 years has primarily been on understanding the relationship between cannabis use and airways diseases9, 10, 11, 12, 13, 14, 15 (Table 1). Smoking cannabis has been associated with an increase in total lung capacity and FVC,9,10,13 potentially resulting from deep-breathing maneuvers of users.9,10 In the setting of heavy, prolonged cannabis use (typically > 20 joint-years),9,11,13,15 a dose-response association between development of airflow
Needs in Future Research
Excellent reviews have been published describing the respiratory tract effects of cannabis, including its influence on inflammation and immunity that may contribute to the development of airways disease or lung cancer.7,28 Notable effects of smoked cannabis on airways include enhanced mucous secretion, airway hyperemia, basal and goblet cell hyperplasia, and squamous metaplasia.29, 30, 31 Additionally, impaired alveolar macrophage phagocytosis and increased apoptosis have been consistently
Conclusions
Increasing prevalence of cannabis consumption in the United States and continued predominant use through an inhaled route suggest an immediate and far-reaching impact on lung health. As the composition of and methods to use cannabis expand, additional research capitalizing on new technologies in cell lines and animal models along with careful consideration addressing deficiencies in prior human clinical investigations will be necessary to establish the effects of cannabis on lung health.
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHESTthat no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.
Other contributions: The authors acknowledge Alicia McNally, BA, for assistance with the manuscript.
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Cited by (33)
Effects of cannabis smoking on the respiratory system: A state-of-the-art review
2024, Respiratory MedicineInhaled Marijuana and the Lung
2022, Journal of Allergy and Clinical Immunology: In PracticeWonder or evil?: Multifaceted health hazards and health benefits of Cannabis sativa and its phytochemicals
2021, Saudi Journal of Biological SciencesTherapeutic Application of Cannabis in Medicine and Its Relevance to Thoracic Surgery
2021, Annals of Thoracic SurgeryCitation Excerpt :Cannabis products exert their effects through a variety of consumption methods, including smoking, vaporizing through electronic nicotine delivery systems, ingestion (“edibles”), patches, and sprays (Figure 3).7 CBD primarily causes anxiolysis, whereas cannabinoids cause euphoria and analgesia.7 Cannabinoids come in many varieties, however, δ-9-tetrahydrocannabinol (THC) is the ingredient that elicits a euphoric effect, and therefore, manufacturers have modulated its potency by means of cultivation, breeding, and genetic manipulation.8
Alcohol and cannabis use alter pulmonary innate immunity
2019, AlcoholCitation Excerpt :Very little is known about how cannabis use alone, and in conjunction with alcohol, affects pulmonary innate immunity and airway inflammation. Published reports indicate that cannabis smokers have more respiratory symptoms such as cough, shortness of breath, sputum production, and wheeze (Biehl & Burnham, 2015; Bloom, Kaltenborn, Paoletti, Camilli, & Lebowitz, 1987; Ribeiro & Ind, 2016). These symptoms are often associated with increased airway inflammation.
FUNDING/SUPPORT: Funding support was provided through National Institutes of Health [Grant T32HL007085 to Dr Biehl].
originally published Online First May 21, 2015.
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