Mehrnaz Ghasemiesfe, MD; Divya Ravi, MD, MPH; Marzieh Vali, MSc; Deborah Korenstein, MD; Mehrdad Arjomandi, MD; James Frank, MD; Peter C. Austin, PhD; Salomeh Keyhani, MD, MPH
Presented in part at the 2018 Society of General Internal Medicine Annual Meeting, Denver, Colorado, 11–14 April 2018.
Note: Dr. Keyhani had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Grant Support: This project was not directly supported by any funds. Dr. Keyhani was supported by grant R01HL130484-01A1 from the National Heart, Lung, and Blood Institute. Dr. Korenstein's contribution to this project was supported in part by a Cancer Center Support Grant (P30 CA008748) to Memorial Sloan Kettering Cancer Center from the National Cancer Institute.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0522.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available at www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017059224. Statistical code: Available from Ms. Vali (e-mail, firstname.lastname@example.org). Data set: See Supplement. Additional data are available from Dr. Ghasemiesfe (e-mail, email@example.com).
Corresponding Author: Mehrnaz Ghasemiesfe, MD, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Ghasemiesfe, Arjomandi, Frank, and Keyhani and Ms. Vali: San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Dr. Ravi: The Wright Center for Graduate Medical Education, 111 North Washington Avenue, Scranton, PA 18503.
Dr. Korenstein: Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017.
Dr. Austin: University of Toronto Institute of Health Policy, Management and Evaluation, G1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Author Contributions: Conception and design: M. Ghasemiesfe, D. Ravi, J. Frank, S. Keyhani.
Analysis and interpretation of the data: M. Ghasemiesfe, M. Vali, D. Korenstein, M. Arjomandi, J. Frank, S. Keyhani.
Drafting of the article: M. Ghasemiesfe, D. Ravi, M. Arjomandi, S. Keyhani.
Critical revision of the article for important intellectual content: M. Ghasemiesfe, D. Korenstein, M. Arjomandi, J. Frank, P.C. Austin, S. Keyhani.
Final approval of the article: M. Ghasemiesfe, D. Ravi, M. Vali, D. Korenstein, M. Arjomandi, J. Frank, P.C. Austin, S. Keyhani.
Provision of study materials or patients: S. Keyhani.
Statistical expertise: M. Vali, P.C. Austin.
Obtaining of funding: S. Keyhani.
Administrative, technical, or logistic support: M. Ghasemiesfe, S. Keyhani.
Collection and assembly of data: M. Ghasemiesfe, D. Ravi, D. Korenstein, S. Keyhani.
The health effects of smoking marijuana are not well-understood.
To examine the association between marijuana use and respiratory symptoms, pulmonary function, and obstructive lung disease among adolescents and adults.
PubMed, Embase, PsycINFO, MEDLINE, and the Cochrane Library from 1 January 1973 to 30 April 2018.
Observational and interventional studies published in English that reported pulmonary outcomes of adolescents and adults who used marijuana.
Four reviewers independently extracted study characteristics and assessed risk of bias. Three reviewers assessed strength of evidence. Studies of similar design with low or moderate risk of bias and sufficient data were pooled.
Twenty-two studies were included. A pooled analysis of 2 prospective studies showed that marijuana use was associated with an increased risk for cough (risk ratio [RR], 2.04 [95% CI, 1.02 to 4.06]) and sputum production (RR, 3.84 [CI, 1.62 to 9.07]). Pooled analysis of cross-sectional studies (1 low and 3 moderate risk of bias) showed that marijuana use was associated with cough (RR, 4.37 [CI, 1.71 to 11.19]), sputum production (RR, 3.40 [CI, 1.99 to 5.79]), wheezing (RR, 2.83 [CI, 1.89 to 4.23]), and dyspnea (RR, 1.56 [CI, 1.33 to 1.83]). Data on pulmonary function and obstructive lung disease were insufficient.
Few studies were at low risk of bias, marijuana exposure was limited in the population studied, cohorts were young overall, assessment of marijuana exposure was not uniform, and study designs varied.
Low-strength evidence suggests that smoking marijuana is associated with cough, sputum production, and wheezing. Evidence on the association between marijuana use and obstructive lung disease and pulmonary function is insufficient.
None. (PROSPERO: CRD42017059224)
Ghasemiesfe M, Ravi D, Vali M, et al. Marijuana Use, Respiratory Symptoms, and Pulmonary Function: A Systematic Review and Meta-analysis. Ann Intern Med. 2018;169:106–115. [Epub ahead of print 3 July 2018]. doi: https://doi.org/10.7326/M18-0522
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Published: Ann Intern Med. 2018;169(2):106-115.
Published at www.annals.org on 3 July 2018
Pulmonary/Critical Care, Tobacco, Alcohol, and Other Substance Abuse.
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