Marijuana Use, Respiratory Symptoms, and Pulmonary Function: A Systematic Review and Meta-analysis
Open accessAbstract
Background: The health effects of smoking marijuana are not well-understood. Purpose: To examine the association between marijuana use and respiratory symptoms, pulmonary function, and obstructive lung disease among adolescents and adults. Data Sources: PubMed, Embase, PsycINFO, MEDLINE, and the Cochrane Library from 1 January 1973 to 30 April 2018. Study Selection: Observational and interventional studies published in English that reported pulmonary outcomes of adolescents and adults who used marijuana. Data Extraction: Four reviewers independently extracted study characteristics and assessed risk of bias. Three reviewers assessed strength of evidence. Studies of similar design with low or moderate risk of bias and sufficient data were pooled. Data Synthesis: Twenty-two studies were included. A pooled analysis of 2 prospective studies showed that marijuana use was associated with an increased risk for cough (risk ratio [RR], 2.04 [95% CI, 1.02 to 4.06]) and sputum production (RR, 3.84 [CI, 1.62 to 9.07]). Pooled analysis of cross-sectional studies (1 low and 3 moderate risk of bias) showed that marijuana use was associated with cough (RR, 4.37 [CI, 1.71 to 11.19]), sputum production (RR, 3.40 [CI, 1.99 to 5.79]), wheezing (RR, 2.83 [CI, 1.89 to 4.23]), and dyspnea (RR, 1.56 [CI, 1.33 to 1.83]). Data on pulmonary function and obstructive lung disease were insufficient. Limitation: Few studies were at low risk of bias, marijuana exposure was limited in the population studied, cohorts were young overall, assessment of marijuana exposure was not uniform, and study designs varied. Conclusion: Low-strength evidence suggests that smoking marijuana is associated with cough, sputum production, and wheezing. Evidence on the association between marijuana use and obstructive lung disease and pulmonary function is insufficient. Primary Funding Source: None. (PROSPERO: CRD42017059224).
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It is unclear the extent to which the respiratory effects are due to cannabis alone or its combined use with tobacco or other confounders.
“It is unclear the extent to which these effects are due to cannabis alone or its combined used with tobacco or other confounders.”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [65]
Regular cannabis smoking is associated with respiratory symptoms of cough, wheezing, and phlegm.
“There is consistent evidence of an association between acute cannabis smoking and bronchodilation and between regular cannabis smoking and respiratory symptoms of cough, wheezing, and phlegm [65].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [65]
Acute cannabis smoking is associated with bronchodilation.
“There is consistent evidence of an association between acute cannabis smoking and bronchodilation and between regular cannabis smoking and respiratory symptoms of cough, wheezing, and phlegm [65].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [65]
The Results (Change in Pulmonary Function) report higher airway resistance in marijuana smokers, but that finding does not address the immediate effect of smoking. A search for acute smoking and bronchodilation found no passage in our copy that addresses the claimed association. (LLM, conf=0.73)
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2. Therapeutic Effects and Harms From Cannabis and Cannabinoids
(2021) · American Public Health Association eBooks · doi:10.2105/9780875533186ch02
- Authors
- Ghasemiesfe, M., Ravi, D., Vali, M., Korenstein, D., Arjomandi, M., Frank, J., Austin, P. C., & Keyhani, S.
- Affiliations
- San Francisco VA Medical Center (US)
- The Wright Center for Graduate Medical Education (US)
- Memorial Sloan Kettering Cancer Center (US)
- University of Toronto (CA)
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2018-07-17
- Volume
- 169
- Issue
- 2
- Pages
- 106-115
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC6231497
- OpenAlex
- W2811304654
- Semantic Scholar
- f90c37d942b40e1c146174aa2ead5d7c532cdabe
- Cited by
- 117
- References
- 47
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 11 · 2023: 27 · 2022: 15 · 2021: 11 · 2020: 14 · 2019: 14 · 2018: 2
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL130484)
- National Cancer Institute (P30CA008748)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- cannabis use, cannabis smoking, respiratory symptoms, lung function, obstructive lung disease, cough, sputum production, wheezing, dyspnea, adolescents, adults
- MeSH terms
- Humans, Lung, Marijuana Smoking, Respiratory Function Tests, Respiratory Tract Diseases
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