Inhaled Cannabis, Asthma, and Chronic Obstructive Pulmonary Disease: A Population-Based Cross-Sectional Study of n = 379,049

Alison S Rustagi^{1

2}, Abra M Jeffers^{3

4

5}, F Julian Graham^{6

7}, Beth E Cohen^{6

8}, Christopher G Slatore^{9

10

11}, Amy L Byers^{6

12

13

14}, Stanton A Glantz¹⁵, Salomeh Keyhani^{6

8}

Affiliations

¹ Center for Data to Discovery and Delivery Innovation (3DI), San Francisco VA Health Care System, San Francisco, CA, USA. alison.rustagi@va.gov.
² Division of General Internal Medicine, University of California-San Francisco, San Francisco, CA, USA. alison.rustagi@va.gov.
³ Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA.
⁴ Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
⁵ Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA.
⁶ Center for Data to Discovery and Delivery Innovation (3DI), San Francisco VA Health Care System, San Francisco, CA, USA.
⁷ Northern California Institute for Research and Education, San Francisco, CA, USA.
⁸ Division of General Internal Medicine, University of California-San Francisco, San Francisco, CA, USA.
⁹ Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
¹⁰ National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA.
¹¹ Division of Pulmonary, Critical Care, and Allergy Medicine, Oregon Health & Science University, Portland, OR, USA.
¹² Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
¹³ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
¹⁴ Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
¹⁵ Retired, Center for Tobacco Control Research & Education and Department of Medicine, University of California, San Francisco, CA, USA.

PMID: 40906010
DOI: 10.1007/s11606-025-09833-8

Inhaled Cannabis, Asthma, and Chronic Obstructive Pulmonary Disease: A Population-Based Cross-Sectional Study of n = 379,049

Alison S Rustagi et al. J Gen Intern Med. 2025.

. 2025 Sep 4.

doi: 10.1007/s11606-025-09833-8. Online ahead of print.

Authors

Affiliations

¹ Center for Data to Discovery and Delivery Innovation (3DI), San Francisco VA Health Care System, San Francisco, CA, USA. alison.rustagi@va.gov.
² Division of General Internal Medicine, University of California-San Francisco, San Francisco, CA, USA. alison.rustagi@va.gov.
³ Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA.
⁴ Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
⁵ Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA.
⁶ Center for Data to Discovery and Delivery Innovation (3DI), San Francisco VA Health Care System, San Francisco, CA, USA.
⁷ Northern California Institute for Research and Education, San Francisco, CA, USA.
⁸ Division of General Internal Medicine, University of California-San Francisco, San Francisco, CA, USA.
⁹ Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
¹⁰ National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA.
¹¹ Division of Pulmonary, Critical Care, and Allergy Medicine, Oregon Health & Science University, Portland, OR, USA.
¹² Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
¹³ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
¹⁴ Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
¹⁵ Retired, Center for Tobacco Control Research & Education and Department of Medicine, University of California, San Francisco, CA, USA.

PMID: 40906010
DOI: 10.1007/s11606-025-09833-8

Abstract

Background: Cannabis may cause chronic pulmonary disease. Prior studies have been limited by low cannabis exposure, lack of data on tobacco cigarettes, and/or limited numbers of those without tobacco cigarette use.

Objective: To examine whether inhaled cannabis associated with asthma and chronic obstructive pulmonary disease, independent of tobacco cigarettes.

Design: Cross-sectional analysis of population-based, nationally representative survey data.

Participants: Adults 18-74 years who participated in the 2016-2020 Behavioral Risk Factor Surveillance System surveys.

Main measures: The exposure was past-30-day cannabis use, from 0 (0/30 days) to 1 (30/30 days). Outcomes were self-reported diagnoses by a medical professional of asthma or chronic obstructive pulmonary disease. We used multivariable logistic regression to test whether inhaled cannabis was associated with odds of disease, adjusted for sociodemographics and tobacco cigarette use (current/former/never). Pre-specified analyses restricted to those with no lifetime tobacco cigarette use.

Key results: Among n = 379,049, n = 23,035 reported inhaled cannabis use. Inhaled cannabis was associated with asthma overall (adjusted odds ratio (aOR) 1.44, 95% CI 1.26-1.63 for daily use) and among n = 221,767 with no lifetime tobacco cigarette use (aOR 1.51 for daily use, 95% CI 1.18-1.93). Inhaled cannabis was associated with chronic obstructive pulmonary disease overall (aOR 1.27 for daily use, 95% CI 1.10-1.46), with a non-significant elevated odds of disease among those with no lifetime tobacco cigarette use (aOR 1.54 for daily use, 95% CI 0.92-2.57).

Conclusions: Inhaled cannabis was associated with asthma and chronic obstructive pulmonary disease after adjusting for tobacco cigarette use. Among those with no lifetime tobacco cigarette use, the association with asthma persisted. Cannabis may be a potential modifiable risk factor for asthma and chronic obstructive pulmonary disease.

Keywords: COPD; asthma; cannabis; marijuana.

PubMed Disclaimer

Conflict of interest statement

Declarations:. Conflict of Interest:: The authors declare no competing interests. Disclaimer:: The study sponsors had no role in the study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the manuscript for publication. The opinions expressed herein are those of the authors and not their employers, the U.S. Department of Veterans Affairs, the U.S. government, or the study sponsors. Human Ethics and Consent to Participate:: This study was based on publicly available de-identified data and was exempt from IRB review. Role of the Sponsors:: The study sponsors had no role in the study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the manuscript for publication. The opinions expressed herein are those of the authors and not their employers or the study sponsors. Institutional Review Board:: This study was based on publicly available de-identified data and was exempt from IRB review.

References

1. Hasin D, Walsh C. Trends over time in adult cannabis use: A review of recent findings. Curr Opin Psychol. 2021;38:80-85. https://doi.org/10.1016/j.copsyc.2021.03.005 - DOI - PubMed - PMC
1. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health. (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58). Published online November 2023. https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-ns...
1. Neff S, Drake MG, Slatore CG, Burnham E. Inhaled Marijuana and the Lungs. Am J Respir Crit Care Med. 2021;204(5):P9-P10. https://doi.org/10.1164/rccm.2044P9 - DOI - PubMed
1. Graves BM, Johnson TJ, Nishida RT, et al. Comprehensive characterization of mainstream marijuana and tobacco smoke. Sci Rep. 2020;10(1):7160. https://doi.org/10.1038/s41598-020-63120-6 - DOI - PubMed - PMC
1. Aldington S, Williams M, Nowitz M, et al. Effects of cannabis on pulmonary structure, function and symptoms. Thorax. 2007;62(12):1058-1063. https://doi.org/10.1136/thx.2006.077081 - DOI - PubMed - PMC

Grants and funding

LinkOut - more resources

Full Text Sources
- Springer
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Inhaled Cannabis, Asthma, and Chronic Obstructive Pulmonary Disease: A Population-Based Cross-Sectional Study of n = 379,049

Affiliations

Inhaled Cannabis, Asthma, and Chronic Obstructive Pulmonary Disease: A Population-Based Cross-Sectional Study of n = 379,049

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous