Table 3

Summary of cannabis-associated bullous lung disease case reports

Author [ref.]Subjects nMean age yearsQuantification of marijuana useTobacco smoking pack- yearsRadiologyComments
Feldman [31]12414–28 g per week for 10 years14Spontaneous pneumothoraxMicroscopy showed ruptured bulla, serosal adhesions and focal atelectasis
Johnson [32]438Two joints per week to three joints per day3 to 15Bilateral upper zone peripheral bullae in all four casesOne patient had paraseptal bullae, two had apical
Rawlins [33]229NAYesBilateral giant lung bullae and severe upper lobe emphysemaNo further investigations documented
Thompson [34]339Moderate for 10 years to heavy for 24 years9 to 20Large upper lobe bullaeNormal α1-antitrypsin levels
Phan [35]12610 pipes a day for 5 years1Bilateral cystic and bullous changes in lower lobesMicroscopy showed fibrosis and macrophage infiltration
Beshay [36]172753 joint-years0 to 25Multiple apical bullae or bullous emphysema in upper lobesHistology showed macrophages
Hii [37]104111 to 149 joint-years1 to 27Asymmetrical bullae peripherally and centrally in upper and mid zones on CTLung function normal in five patients
Reece [38]15610 cigarettes per day for 25 years>1Multiple giant lung cysts on CT scan, no lobe predominanceNormal α1-antitrypsin levels
Gao [39]123NA0Bilateral large upper lobe bullae, recurrent pneumothoraxCystic fibrosis
Allen [40]1181 oz weekly for 4 years3Bilateral apical bullae up to 3 cmHistology showed pigmented macrophages and DIP-like changes
Shah [41]127Heavy use for 10 years20Large left apical bulla and right apical blebsNormal α1-antitrypsin levels
Sood [42]133Off and on for 10 years15VLS on the left sideNormal α1-antitrypsin levels
Gargani [43]241NANA to 39One patient had left apical bullae, the other had right upper and middle lobe bullaeIn both patients, bullae contained Aspergillus
Golwala [44]12524 joint-years1Bilateral bullae with upper lobe predominancePrevious untreated sarcoidosis but no current clinical/radiological features
Tashtoush [45]165Heavy use for 20 years0Bilateral large lung bullae characteristic of VLSPoorly controlled AIDS and previous intravenous heroin use
Fiorelli [46]8307 joints per week to 6 joints per day15 to 40Eight out of 13 marijuana smokers with spontaneous pneumothorax had bullae, six had paraseptal bullae (two with upper lobe involvement)Increased intralveolar pigmented lymphocytes
Cary [47]14886 joint-years25Bilateral upper and mid zone bullous diseaseSputum grew only Candida, no clinical signs of infection
Mishra [48]130Daily use for 5 yearsNoneSpontaneous pneumothorax, apical bullae in the right lungNormal homocysteine, RF and HIV tests

NA: not applicable; CT: computed tomography; DIP: desquamative interstitial pneumonia; VLS: vanishing lung syndrome; RF: rheumatoid factor. Reproduced with modification from [2].