Abstract
Background
Cannabis may cause chronic pulmonary disease. Prior studies have been limited by low cannabis exposure, lack of data on tobacco cigarettes, and/or limited numbers of those without tobacco cigarette use.
Objective
To examine whether inhaled cannabis associated with asthma and chronic obstructive pulmonary disease, independent of tobacco cigarettes.
Design
Cross-sectional analysis of population-based, nationally representative survey data.
Participants
Adults 18–74 years who participated in the 2016–2020 Behavioral Risk Factor Surveillance System surveys.
Main Measures
The exposure was past-30-day cannabis use, from 0 (0/30 days) to 1 (30/30 days). Outcomes were self-reported diagnoses by a medical professional of asthma or chronic obstructive pulmonary disease. We used multivariable logistic regression to test whether inhaled cannabis was associated with odds of disease, adjusted for sociodemographics and tobacco cigarette use (current/former/never). Pre-specified analyses restricted to those with no lifetime tobacco cigarette use.
Key Results
Among n = 379,049, n = 23,035 reported inhaled cannabis use. Inhaled cannabis was associated with asthma overall (adjusted odds ratio (aOR) 1.44, 95% CI 1.26–1.63 for daily use) and among n = 221,767 with no lifetime tobacco cigarette use (aOR 1.51 for daily use, 95% CI 1.18–1.93). Inhaled cannabis was associated with chronic obstructive pulmonary disease overall (aOR 1.27 for daily use, 95% CI 1.10–1.46), with a non-significant elevated odds of disease among those with no lifetime tobacco cigarette use (aOR 1.54 for daily use, 95% CI 0.92–2.57).
Conclusions
Inhaled cannabis was associated with asthma and chronic obstructive pulmonary disease after adjusting for tobacco cigarette use. Among those with no lifetime tobacco cigarette use, the association with asthma persisted. Cannabis may be a potential modifiable risk factor for asthma and chronic obstructive pulmonary disease.
Topic
JGIM
Author Descriptions
Center for Data to Discovery and Delivery Innovation (3DI), San Francisco VA Health Care System, San Francisco, CA, USA
Alison S. Rustagi MD PhD, F. Julian Graham BA, Beth E. Cohen MD MAS, Amy L. Byers PhD MPH & Salomeh Keyhani MD MPH
Division of General Internal Medicine, University of California-San Francisco, San Francisco, CA, USA
Alison S. Rustagi MD PhD, Beth E. Cohen MD MAS & Salomeh Keyhani MD MPH
Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
Abra M. Jeffers PhD
Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
Abra M. Jeffers PhD
Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
Abra M. Jeffers PhD
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
Christopher G. Slatore MD MS
National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
Christopher G. Slatore MD MS
Division of Pulmonary, Critical Care, and Allergy Medicine, Oregon Health & Science University, Portland, OR, USA
Christopher G. Slatore MD MS
Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
Amy L. Byers PhD MPH
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
Amy L. Byers PhD MPH
Retired, Center for Tobacco Control Research & Education and Department of Medicine, University of California, San Francisco, CA, USA
Stanton A. Glantz PhD
Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
Amy L. Byers PhD MPH
Northern California Institute for Research and Education, San Francisco, CA, USA
F. Julian Graham BA
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