Marcus HS Lee, Robert J Hancox

Although cannabis (or marijuana) is the world's most widely-used illicit drug, there has been surprisingly little research into its effects on respiratory health. Part of the problem is the inherent difficulty of studying the long-term effects of an illegal habit. It has often been assumed that smoking cannabis will have similar long-term effects to smoking tobacco. Several recent observational studies suggest that this is not the case and that cannabis has quite different effects on the lung function. There are consistent findings that smoking cannabis is associated with large airway inflammation, symptoms of bronchitis, increased airway resistance and lung hyperinflation. The evidence that smoking cannabis leads to features of chronic obstructive pulmonary disease, such as airflow obstruction and emphysema is not convincing. However, there are numerous case reports of bullous emphysema among cannabis smokers. These findings have not been confirmed in systematic analytical studies and probably represent uncommon adverse effects in very heavy cannabis smokers. There is now additional controversial evidence that cannabis is at least an occasional cause of respiratory malignancies, but again the evidence is inconclusive.