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Marijuana Use Linked to Lower Hospital Mortality in COPD Patients

— Users also had less pneumonia

by Ed Susman, Contributing Writer, MedPage Today October 21, 2020

Patients diagnosed with chronic obstructive pulmonary disease (COPD) who reported using marijuana had less risk of in-hospital mortality and pneumonia than non-users, according to a nationwide population-based study.

Use of marijuana was associated with a 37.6% reduction in the odds of dying in the hospital (OR 0.624, 95% CI 0.407-0.958, P=0.0309) among patients diagnosed with COPD, reported Kulothungan Gunasekaran, MBBS, a hospitalist resident at Bridgeport Hospital/Yale New Haven Health in Connecticut, at the virtual CHEST conference, the annual meeting of the American College of Chest Physicians.

Gunasekaran and colleagues also found that COPD patients who admitted marijuana use had an 11.8% lower risk of pneumonia (OR 0.882, 95% CI 0.806-0.964, P=0.0059).

“Among hospitalized patients with a diagnosis of COPD, marijuana users had statistically significant lower odds of in-hospital mortality and pneumonia compared to non-marijuana users,” Gunasekaran reported in his poster presentation.

“The association between marijuana use and these favorable outcomes deserves further study to understand the interaction between marijuana use and COPD, as this can have significant public health impact,” he said.

Yili Huang, DO, director of the Pain Management Center at Northwell Health’s Phelps Hospital in Sleepy Hollow, New York, told MedPage Today, “Interestingly, studies have shown that marijuana smoking is associated with increased lung capacity. It is possible that cannabis can initially help open airways in the lungs and have an anti-inflammatory effect. This may be part of the reasons that the COPD patients who are marijuana users have lower mortality in this study.”

However, Huang also noted that there are other studies that indicated cannabis use is associated with other lung diseases in patients with COPD.

Additionally, the COPD patients who admitted to using marijuana in the study were younger than the general population, and that could have had an impact on in-hospital mortality, he said.

Huang, who was not involved with the study, suggested that the association between marijuana use and reductions in mortality and pneumonia were likely “more correlation than causation.”

For the study, Gunasekaran and his team performed a retrospective analysis of COPD-associated hospitalizations using the Nationwide Inpatient Sample over the years 2005-2014.

The researchers identified 6,073,862 hospitalizations of people over the age of 18 with COPD using hospital discharge codes. Of that group, 24,546, or 0.4%, were admitted with marijuana use. About 60% of the patients who were admitted with marijuana use were in the age bracket of 50-64, while marijuana use in the group ages 65-79 was about 43%.

Marijuana users were likely to have fewer diagnoses of sepsis and acute respiratory failure, but these differences did not reach statistical significance.

In their abstract discussion of the findings, Gunasekaran and his team wrote, “With increasing marijuana use in our hospitalized population, it is now important to recognize its impact on patients with underlying chronic lung disease.

“Recreational marijuana abuse suffers from reporting bias due to its controversial social and legal nature. Also, administrative databases are prone to coding inaccuracies as they rely on clinician’s documentation and coder’s expertise,” they noted. “Thus, our data might have underestimated the prevalence of marijuana use.”

Gunasekaran and Huang disclosed no relevant relationships with industry.

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Users also had less pneumonia

Marijuana and COPD: Is There a Connection?

Chronic obstructive pulmonary disease (COPD) is connected to breathing irritants. For this reason, researchers have been curious about a link between COPD and smoking marijuana.

Marijuana use is not uncommon. A national survey in 2017 showed that 45 percent of high school seniors reported using marijuana in their lifetime. About 6 percent said they used it on a daily basis, while reported daily use of tobacco was just 4.2 percent.

Use among adults is growing as well. A 2015 report noted that marijuana use doubled among U.S. adults over a 10-year span. In 2018, researchers found that the greatest increase in marijuana use since 2000 has been among adults age 50 and older.

COPD is an umbrella term that describes chronic lung conditions such as emphysema, chronic bronchitis, and nonreversible asthma-like symptoms. It’s a common condition in people who have a history of smoking.

In fact, it’s estimated that 90 percent of people with COPD have smoked or currently smoke. In the United States, about 30 million people have COPD, and half of them don’t know.

So could smoking marijuana increase your risk of COPD? Read on to learn what researchers have found about marijuana use and lung health.

Marijuana smoke contains many of the same chemicals as cigarette smoke. Marijuana also has a higher combustion rate, or burn rate. The short-term effect of smoking marijuana may depend on the dose.

However, repeated and consistent use of marijuana may increase the risk of poor respiratory health. Smoking marijuana long-term can:

  • increase coughing episodes
  • increase mucus production
  • damage mucus membranes
  • increase risk of lung infections

But it’s the habits that may play the largest role in overall lung health. People often smoke marijuana differently than they smoke cigarettes. For example, they may hold smoke longer and deeper into the lungs and smoke to a shorter butt length.

Holding in the smoke affects the amount of tar the lungs retain. Compared to smoking tobacco, a 2014 review of studies shows that marijuana inhalation techniques cause four times more tar to be inhaled. A third more tar gets into the lower airways.

Longer and deeper inhalations also increase the carboxyhemoglobin concentration in your blood by five times. Carboxyhemoglobin is created when carbon monoxide bonds with the hemoglobin in your blood.

When you smoke, you inhale carbon monoxide. It’s more likely to bind to hemoglobin than oxygen is. As a result, your hemoglobin carries more carbon monoxide and less oxygen through your blood.

There is significant interest in studying marijuana. Scientists want to learn about its medical and relaxation purposes as well as its direct relationship to lung issues like COPD. But there are many legal, social, and practical limitations.

Factors that impact research and results include:

Marijuana’s classification

Marijuana is a Schedule 1 drug. This means the U.S. Food and Drug Administration doesn’t consider the drug to have a medical purpose. Schedule 1 drugs are classified this way because they’re thought to have a high chance of abuse.

Marijuana’s classification makes studying its use expensive and time-consuming.

Quality tracking

The amount of THC and other chemicals in marijuana can change based on the strain. The chemicals inhaled can also change based on the size of the cigarette or how much smoke is inhaled. Controlling for quality and comparing across studies can be difficult.

Consumption tracking

It’s difficult to keep track of how much of the active ingredients are consumed. The average person can’t identify the dose they’ve smoked. Most studies also focus on frequency of use but ignore other details that may affect health and a study’s results.

These factors include:

  • joint size
  • intensity of how someone smokes a joint
  • whether people share joints
  • use of a water pipe or vaporizer

Even though research is limited for marijuana, smoking anything can be unhealthy for your lungs. Most COPD symptoms aren’t noticeable until the condition has progressed and a certain amount of lung damage has occurred.

Still, keep an eye out for the following symptoms:

  • shortness of breath
  • wheezing
  • chronic cough
  • chest tightness
  • frequent colds and other respiratory infections

More serious symptoms of COPD go along with more severe lung damage. They include:

  • swelling in your feet, legs, and hands
  • extreme weight loss
  • inability to catch your breath
  • blue fingernails or lips

Call your doctor right away if you experience any of these symptoms, especially if you have a history of smoking.

Marijuana smoke has many of the same chemicals as tobacco, but the link between marijuana use and COPD is not as clear. Learn what research says.