Table 2. Summary of case studies and case series on the association between cannabis smoking and bullous lung disease.

Author (year)	Subjects (n)	Mean age	Marijuana smoking	Tobacco smoking (pack-years)	Results
Feldman et al.71	1	24	14–28 g/week for 10 years	14	Spontaneous pneumothorax. Microscopy showed ruptured bulla, serosal adhesions and focal atelectasis
Johnson et al.49	4	38	2 joints/week to 3 joints/day	3–15	Bilateral upper zone peripheral bullae in all four cases. One with paraseptal and two with apical bullous emphysema
Rawlins et al.72	2	29	Yesa	Yesa	Bilateral giant lung bullae and severe upper lobe emphysema
Thompson et al.73	3	39	'Moderate' for 10 years to 'heavy' for 24 years	9–20	Large upper lobe bullae
Phan et al.74	1	26	10 pipes a day for 5 years	1	Bilateral cystic and bullous changes in lower lobes. Microscopy showed fibrosis and macrophage infiltration
Beshay et al.75	17	27	53 joint-years	0–25	Multiple apical bullae or bullous emphysema in upper lobes. Histology showed macrophages
Hii et al.51	10	41	11–149 joint-years	1–27	Asymmetrical bullae peripherally and centrally in upper and mid zones.
Reece76	1	56	10 cigarettes per day for 25 years	>1	Mixed tobacco and cannabis in joint. Multiple giant lung cysts on CT scan, no lobe predominance.
Gao et al.77	1	23	Yesa	None	Cystic fibrosis. Bilateral large upper lobe bullae. Recurrent pneumothorax
Allen78	1	18	1 oz weekly for 4 years	3	Bilateral apical bullae up to 3 cm. Histology showed emphysematous changes with pigmented macrophages and DIP-like changes.
Shah et al.79	1	27	‘Heavy’ use for 10 years	20	Large left apical bulla and right apical blebs. CT scan following chest drain of pneumothorax
Sood et al.80	1	33	‘Off and on’ for 10 years	15	VLS on the left side shown on chest X-ray and CT scan
Gargani et al.81	2	41	Yesa	NA to 39	One patient had left apical bullae, the other had right upper and middle lobe bullae. In both patients, one bulla contained Aspergillus
Golwala82	1	25	24 joint-years	1	Bilateral bullae with upper lobe predominance. Previous untreated sarcoidosis but no current clinical/radiological features
Tashtoush et al.83	1	65	‘Heavy ’ use for 20 years	None	Poorly controlled AIDS and previous IV heroin use. Bilateral large lung bullae characteristic of VLS
Fiorelli et al.84	8	30	7 joints per week to 6 joints per day	15–40	Eight of 13 marijuana smokers with spontaneous pneumothorax had bullae on CT scan. Six had paraseptal bullae and two had upper lobe involvement
Cary et al.85	1	48	86 joint-years	25	Bilateral upper and mid zone bullous disease. Air fluid level seen on left lung bulla. Sputum grew only Candida; no clinical signs of infection.

Abbreviations: CT, computerised tomography; DIP, desquamative interstitial pneumonia; IV, intravenous; VLS, vanishing lung syndrome.

^aUndocumented amount.