Marijuana Use Associations with Pulmonary Symptoms and Function in Tobacco Smokers Enrolled in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS)

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Abstract

Background: Marijuana is often smoked via a filterless cigarette and contains similar chemical makeup as smoked tobacco. There are few publications describing usage patterns and respiratory risks in older adults or in those with chronic obstructive pulmonary disease (COPD).

Methods: A cross-sectional analysis of current and former tobacco smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) study assessed associations between marijuana use and pulmonary outcomes. Marijuana use was defined as never, former (use over 30 days ago), or current (use within 30 days). Respiratory health was assessed using quantitative high-resolution computed tomography (HRCT) scans, pulmonary function tests and questionnaire responses about respiratory symptoms.

Results: Of the total 2304 participants, 1130 (49%) never, 982 (43%) former, and 192 (8%) current marijuana users were included. Neither current nor former marijuana use was associated with increased odds of wheeze (odds ratio [OR] 0.87, OR 0.97), cough (OR 1.22; OR 0.93) or chronic bronchitis (OR 0.87; OR 1.00) when compared to never users. Current and former marijuana users had lower quantitative emphysema ( P=0.004, P=0.03), higher percent predicted forced expiratory volume in 1 second (FEV ₁%) ( P<0.001, P<0.001), and percent predicted forced vital capacity (FVC%) ( p<0.001, P<0.001). Current marijuana users exhibited higher total tissue volume ( P=0.003) while former users had higher air trapping ( P<0.001) when compared to never marijuana users.

Conclusions: Marijuana use was found to have little to no association with poor pulmonary health in older current and former tobacco smokers after adjusting for covariates. Higher forced expiratory volume in 1 second (FEV ₁) and forced vital capacity (FVC) was observed among current marijuana users. However, higher joint years was associated with more chronic bronchitis symptoms (e.g., wheeze), and this study cannot determine if long-term heavy marijuana smoking in the absence of tobacco smoking is associated with lung symptoms, airflow obstruction, or emphysema, particularly in those who have never smoked tobacco cigarettes.

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Journal ID (nlm-ta): Chronic Obstr Pulm Dis

Journal ID (iso-abbrev): Chronic Obstr Pulm Dis

Journal ID (publisher-id): Chronic Obstr Pulm Dis

Title: Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation

Publisher: COPD Foundation Inc (Miami, USA )

ISSN (Electronic): 2372-952X

Publication date Collection: 2018

Publication date Created: 24 January 2018

Volume: 5

Issue: 1

Pages: 46-56

Affiliations

[1]1-National Jewish Health, Denver, Colorado

[2]2-Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora

[3]3-Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California at Los Angeles

[4]4-Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, School of Medicine, San Francisco

[5]5-Departments of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City

[6]6-University of Utah Health Sciences Center, Salt Lake City

[7]7-Department of Biostatics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora

[8]8-Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill

[9]9-Columbia University, Division of General Medicine, New York, New York

[10]10-University Michigan Health System, Ann Arbor

[11]11-Johns Hopkins University, Baltimore, Maryland

Author notes

Address correspondence to: Russell Bowler and Madeline A. Morris Department of Medicine, Division of Pulmonary Medicine National Jewish Health Denver, Colorado bowler@ 123456njhealth.org mamorris8@ 123456gmail.com (303)270-2014

The authors thank the SPIROMICS participants and participating physicians, investigators and staffs for making this research possible. We would like to acknowledge the following current and former investigators of the SPIROMICS sites and reading centers: Neil Alexis, PhD; Wayne Anderson, PhD; R. Graham Barr, MD, DrPH; Eugene Bleecker, MD; Richard C. Boucher, MD; Russell Bowler, MD, PhD; Stephanie Christenson, MD; Alejandro P. Comellas, MD; Christopher B. Cooper, MD, PhD; David Couper, PhD; Gerard Criner, MD; Ronald G. Crystal, MD; Jeffrey L. Curtis, MD; Claire Doerschuk, MD; Mark Dransfield, MD; Christine M. Freeman, PhD; MeiLan K. Han, MD, MS; Nadia N. Hansel, MD, MPH; Eric A. Hoffman, PhD; Robert J. Kaner, MD; Richard Kanner, MD; Eric Kleerup, MD; Jerry Krishnan, MD, PhD; Lisa LaVange, MA, PhD; Stephen C. Lazarus, MD; Fernando J. Martinez, MD, MS; Wanda O’Neal, PhD; Robert Paine, III, MD; Nirupama Putcha, MD, MHS; Steve Rennard, MD; Donald Tashkin, MD; Mary Beth Scholand, MD; Robert A. Wise, MD; and Prescott G. Woodruff, MD, MPH. The project officers from the Lung Division of the National Heart, Lung, and Blood Institute were Lisa Postow, PhD, and Thomas Croxton, PhD, MD. SPIROMICS was supported by contracts from the National Institutes of Health/National Heart, Lung, and Blood Institute (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C HHSN268200900019C, HHSN268200900020C), which were supplemented by contributions made through the Foundation for the National Institutes of Health from AstraZeneca; Bellerophon Therapeutics; Boehringer- Ingelheim Pharmaceuticals, Inc; Chiesi Farmaceutici SpA; Forest Research Institute, Inc; GlaxoSmithKline; Grifols Therapeutics, Inc; Ikaria, Inc; Nycomed GmbH; Takeda Pharmaceutical Company; Novartis Pharmaceuticals Corporation; Regeneron Pharmaceuticals, Inc; and Sanofi.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Article

Accession ID: PMC5870739 Pmcid ID: PMC5870739 Pmc-uid ID: 5870739

DOI: 10.15326/jcopdf.5.1.2017.0141

PMC ID: 5870739

PubMed ID: 29629404

SO-VID: c6a993f1-d907-4419-8e72-fb95094dcbab

History

Date accepted : 24 October 2017

Funding

This study was supported by the National Heart, Lung, and Blood Institute (NHLBI R01HL 095432, R01 HL089856, R01 HL089897); and UL1 RR025680 from NCRR/HIH. The Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) is funded by contract from the National Heart, Lung, and Blood Institute (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN2682009000019C, HHSN268200900020C)

Marijuana Use Associations with Pulmonary Symptoms and Function in Tobacco Smokers Enrolled in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS)

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