Association between marijuana exposure and pulmonary function over 20 years

Abstract

Context: Marijuana smoke contains many of the same constituents as tobacco smoke, but whether it has similar adverse effects on pulmonary function is unclear.

Objective: To analyze associations between marijuana (both current and lifetime exposure) and pulmonary function.

Design, setting, and participants: The Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal study collecting repeated measurements of pulmonary function and smoking over 20 years (March 26, 1985-August 19, 2006) in a cohort of 5115 men and women in 4 US cities. Mixed linear modeling was used to account for individual age-based trajectories of pulmonary function and other covariates including tobacco use, which was analyzed in parallel as a positive control. Lifetime exposure to marijuana joints was expressed in joint-years, with 1 joint-year of exposure equivalent to smoking 365 joints or filled pipe bowls.

Main outcome measures: Forced expiratory volume in the first second of expiration (FEV(1)) and forced vital capacity (FVC).

Results: Marijuana exposure was nearly as common as tobacco exposure but was mostly light (median, 2-3 episodes per month). Tobacco exposure, both current and lifetime, was linearly associated with lower FEV(1) and FVC. In contrast, the association between marijuana exposure and pulmonary function was nonlinear (P < .001): at low levels of exposure, FEV(1) increased by 13 mL/joint-year (95% CI, 6.4 to 20; P < .001) and FVC by 20 mL/joint-year (95% CI, 12 to 27; P < .001), but at higher levels of exposure, these associations leveled or even reversed. The slope for FEV(1) was -2.2 mL/joint-year (95% CI, -4.6 to 0.3; P = .08) at more than 10 joint-years and -3.2 mL per marijuana smoking episode/mo (95% CI, -5.8 to -0.6; P = .02) at more than 20 episodes/mo. With very heavy marijuana use, the net association with FEV(1) was not significantly different from baseline, and the net association with FVC remained significantly greater than baseline (eg, at 20 joint-years, 76 mL [95% CI, 34 to 117]; P < .001).

Conclusion: Occasional and low cumulative marijuana use was not associated with adverse effects on pulmonary function.

Figure 1. Pulmonary function measurements by age

Participants (n=5017) contributed an average of 3.9 measurements per person (n=19705 total) over the course of 20 years. Note that many points overlap, and that FVC observations are offset by 0.3 years so that the points do not fall on top of the FEV1 observations. A lowess smoother was used to calculate the smoothed average. Grey circles (below zero on the y-axis) illustrate the number of observations used at each age. FEV1 – Forced expiratory volume in 1 second; FVC – Forced vital capacity.

Figure 2. Associations between continuous smoothed exposure to current and lifetime tobacco and marijuana and pulmonary function

Associations between continuous current and lifetime exposure measurements and pulmonary function were modeled via cubic splines (see Methods). All four exposure measurements were included in each model (one model each for FEV1 and FVC). Mixed models with a random intercept and a random 3-knot age spline were used to adjust for repeated measures, and fixed effects were included for year, center and center-year (their interaction), race-sex category, education, asthma; cubic splines for age, height, waist circumference, second hand smoke exposure, PM10 and PM2.5; and interactions between the age spline variables and race-sex, asthma, waist spline variables, and height spline variables. Point estimates and confidence intervals for slopes and net associations at different exposure levels are provided in Table 3. FEV1 – Forced expiratory volume in 1 second; FVC – Forced vital capacity.

Figure 2. Associations between continuous smoothed exposure to current and lifetime tobacco and marijuana and pulmonary function

Associations between continuous current and lifetime exposure measurements and pulmonary function were modeled via cubic splines (see Methods). All four exposure measurements were included in each model (one model each for FEV1 and FVC). Mixed models with a random intercept and a random 3-knot age spline were used to adjust for repeated measures, and fixed effects were included for year, center and center-year (their interaction), race-sex category, education, asthma; cubic splines for age, height, waist circumference, second hand smoke exposure, PM10 and PM2.5; and interactions between the age spline variables and race-sex, asthma, waist spline variables, and height spline variables. Point estimates and confidence intervals for slopes and net associations at different exposure levels are provided in Table 3. FEV1 – Forced expiratory volume in 1 second; FVC – Forced vital capacity.

Figure 2. Associations between continuous smoothed exposure to current and lifetime tobacco and marijuana and pulmonary function

Associations between continuous current and lifetime exposure measurements and pulmonary function were modeled via cubic splines (see Methods). All four exposure measurements were included in each model (one model each for FEV1 and FVC). Mixed models with a random intercept and a random 3-knot age spline were used to adjust for repeated measures, and fixed effects were included for year, center and center-year (their interaction), race-sex category, education, asthma; cubic splines for age, height, waist circumference, second hand smoke exposure, PM10 and PM2.5; and interactions between the age spline variables and race-sex, asthma, waist spline variables, and height spline variables. Point estimates and confidence intervals for slopes and net associations at different exposure levels are provided in Table 3. FEV1 – Forced expiratory volume in 1 second; FVC – Forced vital capacity.

Figure 2. Associations between continuous smoothed exposure to current and lifetime tobacco and marijuana and pulmonary function

Associations between continuous current and lifetime exposure measurements and pulmonary function were modeled via cubic splines (see Methods). All four exposure measurements were included in each model (one model each for FEV1 and FVC). Mixed models with a random intercept and a random 3-knot age spline were used to adjust for repeated measures, and fixed effects were included for year, center and center-year (their interaction), race-sex category, education, asthma; cubic splines for age, height, waist circumference, second hand smoke exposure, PM10 and PM2.5; and interactions between the age spline variables and race-sex, asthma, waist spline variables, and height spline variables. Point estimates and confidence intervals for slopes and net associations at different exposure levels are provided in Table 3. FEV1 – Forced expiratory volume in 1 second; FVC – Forced vital capacity.