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Ann Intern Med. 2018 Jul 17;169(2):106-115. doi: 10.7326/M18-0522. Epub 2018 Jul 3.

Marijuana Use, Respiratory Symptoms, and Pulmonary Function: A Systematic Review and Meta-analysis.

Author information

University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California (M.G., M.A., J.F., S.K.).
The Wright Center for Graduate Medical Education, Scranton, Pennsylvania (D.R.).
Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, San Francisco, California (M.V.).
Memorial Sloan Kettering Cancer Center, New York, New York (D.K.).
University of Toronto, Toronto, Ontario, Canada (P.C.A.).



The health effects of smoking marijuana are not well-understood.


To examine the association between marijuana use and respiratory symptoms, pulmonary function, and obstructive lung disease among adolescents and adults.

Data Sources:

PubMed, Embase, PsycINFO, MEDLINE, and the Cochrane Library from 1 January 1973 to 30 April 2018.

Study Selection:

Observational and interventional studies published in English that reported pulmonary outcomes of adolescents and adults who used marijuana.

Data Extraction:

Four 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 Synthesis:

Twenty-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.


Few 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.


Low-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 Source:

None. (PROSPERO: CRD42017059224).

[Indexed for MEDLINE]
Free PMC Article

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