Effects of Marijuana Smoking on Pulmonary Function and Respiratory Complications
The relationship between marijuana smoking and pulmonary function or respiratory complications is poorly understood; therefore, we conducted a systematic review of the impact of marijuana smoking on pulmonary function and respiratory complications.

Methods: Studies that evaluated the effect of marijuana smoking on pulmonary function and respiratory complications were selected from the MEDLINE, PsychINFO, and EMBASE databases according to predefined criteria from January 1, 1966, to October 28, 2005. Two independent reviewers extracted data and evaluated study quality based on established criteria. Study results were critically appraised for clinical applicability and research methods.

Results: Thirty-four publications met selection criteria. Reports were classified as challenge studies if they examined the association between short-term marijuana use and airway response; other reports were classified as studies of long-term marijuana smoking and pulmonary function or respiratory complications. Eleven of 12 challenge studies found an association between short term marijuana administration and bronchodilation (eg, increases of 0.15-0.25 L in forced expiratory volume in 1 second). No consistent association was found between long-term marijuana smoking and airflow obstruction measures. All 14 studies that assessed long-term marijuana smoking and respiratory complications noted an association with increased respiratory symptoms, including cough, phlegm, and wheeze (eg, odds ratio, 2.00; 95% confidence interval, 1.32-3.01, for the association between marijuana smoking and cough). Studies were variable in their overall quality (eg, controlling for confounders, including tobacco smoking).

Conclusions: Short-term exposure to marijuana is associated with bronchodilation. Physiologic data were inconclusive regarding an association between long-term marijuana smoking and airflow obstruction measures. Long-term marijuana smoking is associated with increased respiratory symptoms suggestive of obstructive lung disease.
Arch Intern Med. 2007;167:221-228.

Marijuana remains the most commonly used illicit drug in the United States, with 14.6 million people 12 years and older reporting current use. [ 1 ] The prevalence of marijuana abuse and dependence continues to increase and occurs in 18% of past-year marijuana users. [ 2 ] Given the persistently high prevalence of marijuana use, abuse, and dependence in the community, it is important to understand the potential adverse health outcomes that result from both short-term and long-term marijuana smoking.

Marijuana and tobacco smoke share many of the same compounds. Tobacco smoking is associated with numerous adverse pulmonary clinical outcomes, affecting both pulmonary function and respiratory complications. Some of the known tobacco smoking–related adverse effects include cough, chronic bronchitis, impairment of gas exchange, and airway obstruction that leads to chronic obstructive pulmonary disease. [ 3,4 ] The adverse impact of marijuana smoking on pulmonary function and respiratory complications has not been systematically assessed.

The purpose of the current review is to determine the association between short-term marijuana smoking and airway response and the association between long-term marijuana smoking and pulmonary function or respiratory complications.

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