Impact of Marijuana Smoking on COPD Progression in a Cohort of Middle-Aged and Older Persons

Igor Barjaktarevic; Christopher B Cooper; Tracie Shing; Russell G Buhr; Eric A Hoffman; Prescott G Woodruff; M Bradley Drummond; Richard E Kanner; MeiLan K Han; Nadia N Hansel; Russell P Bowler; Gregory L Kinney; Sean Jacobson; Madeline A Morris; Fernando J Martinez; Jill Ohar; David Couper; Donald P Tashkin

doi:10.15326/jcopdf.2022.0378

Impact of Marijuana Smoking on COPD Progression in a Cohort of Middle-Aged and Older Persons

Chronic Obstr Pulm Dis. 2023 Jul 26;10(3):234-247. doi: 10.15326/jcopdf.2022.0378.

Authors

Igor Barjaktarevic¹, Christopher B Cooper¹, Tracie Shing², Russell G Buhr^{1

3}, Eric A Hoffman⁴, Prescott G Woodruff⁵, M Bradley Drummond⁶, Richard E Kanner⁷, MeiLan K Han⁸, Nadia N Hansel⁹, Russell P Bowler¹⁰, Gregory L Kinney¹¹, Sean Jacobson¹¹, Madeline A Morris¹², Fernando J Martinez¹³, Jill Ohar¹⁴, David Couper², Donald P Tashkin¹

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States.
² Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling's School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States.
³ Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, United States.
⁴ Departments of Radiology, Medicine and Bioengineering, University of Iowa, Iowa City, Iowa, United States.
⁵ Division of Pulmonary and Critical Care Medicine; Department of Medicine, University of California; San Francisco, California, United States.
⁶ Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States.
⁷ Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States.
⁸ Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States.
⁹ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
¹⁰ Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States.
¹¹ Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
¹² College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, United States.
¹³ Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States.
¹⁴ Division of Pulmonary, Critical Care, Allergy and Immunology, School of Medicine, Wake Forest University, Wake Forest, North Carolina, United States.

Abstract

Background: Limited data are available regarding marijuana smoking's impact on the development or progression of chronic obstructive pulmonary disease (COPD) in middle-aged or older adults with a variable history of tobacco cigarette smoking.

Methods: We divided ever-tobacco smoking participants in the SubPopulations and InteRmediate Outcomes In COPD Study (SPIROMICS) into 3 groups based on self-reported marijuana use: current, former, or never marijuana smokers (CMSs, FMSs or NMSs, respectively). Longitudinal data were analyzed in participants with ≥2 visits over a period of ≥52 weeks.

Measurements: We compared CMSs, FMSs, and NMSs, and those with varying amounts of lifetime marijuana use. Mixed effects linear regression models were used to analyze changes in spirometry, symptoms, health status, and radiographic metrics; zero-inflated negative binomial models were used for exacerbation rates. All models were adjusted for age, sex, race, baseline tobacco smoking amount, and forced expiratory volume in 1 second (FEV₁) %predicted.

Results: Most participants were followed for ≥4 years. Annual rates of change in FEV₁, incident COPD, respiratory symptoms, health status, radiographic extent of emphysema or air trapping, and total or severe exacerbations were not different between CMSs or FMSs versus NMSs or between those with any lifetime amount of marijuana use versus NMSs.

Conclusions: Among SPIROMICS participants with or without COPD, neither former nor current marijuana smoking of any lifetime amount was associated with evidence of COPD progression or its development. Because of our study's limitations, these findings underscore the need for further studies to better understand longer-term effects of marijuana smoking in COPD.

Keywords: COPD; Exacerbations; HRCT; Marijuana; Spirometry.

Abstract

Grants and funding