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A Systematic Review

Jeanette M. Tetrault, MD; Kristina Crothers, MD; Brent A. Moore, PhD; Reena Mehra, MD, MS; John Concato, MD, MS, MPH; David A. Fiellin, MD

Arch Intern Med. 2007;167(3):221-228.

Background  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.

Author Affiliations: Clinical Epidemiology Research Center, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center, West Haven, Conn (Drs Tetrault and Concato); Departments of Medicine (Drs Tetrault, Crothers, Concato, and Fiellin) and Psychiatry (Dr Moore), Yale University School of Medicine, New Haven, Conn; and Department of Medicine, Case Western University School of Medicine, Cleveland, Ohio (Dr Mehra).

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