JRSM > Volume 99, Number 4 > Pp. 169-170

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Letters

Cannabis, pneumothorax and lung bullae

Anthony Gill

Royal North Shore Hospital, Sydney, Australia

E-mail: affgill{at}med.usyd.edu.au

In a recent review (February 2006 JRSM¹), the relationship between pneumothorax and cannabis was questioned (or at least not highlighted). There are too many reports describing pneumothorax, pneumediastinum and even pneumoarachis associated with cannabis for this to be a coincidence particularly as many reports describe the onset of symptoms whilst actually smoking drugs. In one series 13 of 15 consecutive patients with `spontaneous' pneumomediastinum or subcutaneous emphysema admitted to `using marijuana extensively before coming to hospital' and the remaining two performed the Valsalva manoeuvre during heroin injection.² The link between cannabis and pneumothorax/pneumomediastinum may or may not be due to barotrauma but it is quite definite. It is recognized by users and frequently discussed on their Internet message boards.

The authors of the review were in error to use a mucosal biopsy study of drug smokers which does not mention bullae as evidence against a causative link with this disease.³ Mucosal biopsies do not include alveolar lung tissue and cannot assess bullous disease. When I studied lung pathology in cannabis smokers I examined wedge resections of lung with blebs and bullae performed for recurrent pneumothorax.⁴ Ten of 108 patients of all ages undergoing this procedure had definite regular cannabis use recorded in their medical records. However, most patients' records did not record whether or not drugs were used and many patients whose smoking status was unrecorded showed histopathological features suggestive of cannabis use. In fact, controls for this study had to be recruited prospectively with repeated reassurance of confidentiality.

Given that patients under-report drug use, this indicates that the number of patients with bullous lung disease who smoke cannabis regularly is probably much higher than 10% (the number of regular users in this population).⁵

REFERENCES

1. Tan C, Hatam N, Treasure T. Bullous disease of the lung and cannabis smoking: insufficient evidence for a causative link. J R Soc Med 2006; 99:77 -80[Free Full Text]

2. Mattox KL, Pneumomediastinum in heroin and marijuana users. J Am Coll Emerg Physicians1976; 5:26 -8

3. Fligiel SE, Roth MD, Kleerup EC, Barsky SH, Simmons MS, Tashink DP. Transbronchial histopathology in habitual smokers of cocaine, marijuana and/or tobacco. Chest1999; 112:319 -26

4. Gill A. Bong lung: regular smokers of cannabis show relatively distinctive histological changes that predispose to pneumothorax. Am J Surg Pathol2005; 29:980 -2[Medline]

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gill, A. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?