• Mehrnaz Ghasemiesfe, Divya Ravi, Marzieh Vali, Deborah Korenstein, Mehrdad Arjomandi, James Frank, Peter C Austin, and Salomeh Keyhani.
• University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California (M.G., M.A., J.F., S.K.).
• Ann. Intern. Med. 2018 Jul 17; 169 (2): 106115106-115.

BackgroundThe health effects of smoking marijuana are not well-understood.PurposeTo examine the association between marijuana use and respiratory symptoms, pulmonary function, and obstructive lung disease among adolescents and adults.Data SourcesPubMed, Embase, PsycINFO, MEDLINE, and the Cochrane Library from 1 January 1973 to 30 April 2018.Study SelectionObservational and interventional studies published in English that reported pulmonary outcomes of adolescents and adults who used marijuana.Data ExtractionFour 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 SynthesisTwenty-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.LimitationFew 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.ConclusionLow-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 SourceNone. (PROSPERO: CRD42017059224).

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