Table 3.
Summary of cannabis-associated bullous lung disease case reports
| Author [ref.] | Subjects n | Mean age years | Quantification of marijuana use | Tobacco smoking pack- years | Radiology | Comments |
| Feldman [31] | 1 | 24 | 14–28 g per week for 10 years | 14 | Spontaneous pneumothorax | Microscopy showed ruptured bulla, serosal adhesions and focal atelectasis |
| Johnson [32] | 4 | 38 | Two joints per week to three joints per day | 3 to 15 | Bilateral upper zone peripheral bullae in all four cases | One patient had paraseptal bullae, two had apical |
| Rawlins [33] | 2 | 29 | NA | Yes | Bilateral giant lung bullae and severe upper lobe emphysema | No further investigations documented |
| Thompson [34] | 3 | 39 | Moderate for 10 years to heavy for 24 years | 9 to 20 | Large upper lobe bullae | Normal α1-antitrypsin levels |
| Phan [35] | 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 [36] | 17 | 27 | 53 joint-years | 0 to 25 | Multiple apical bullae or bullous emphysema in upper lobes | Histology showed macrophages |
| Hii [37] | 10 | 41 | 11 to 149 joint-years | 1 to 27 | Asymmetrical bullae peripherally and centrally in upper and mid zones on CT | Lung function normal in five patients |
| Reece [38] | 1 | 56 | 10 cigarettes per day for 25 years | >1 | Multiple giant lung cysts on CT scan, no lobe predominance | Normal α1-antitrypsin levels |
| Gao [39] | 1 | 23 | NA | 0 | Bilateral large upper lobe bullae, recurrent pneumothorax | Cystic fibrosis |
| Allen [40] | 1 | 18 | 1 oz weekly for 4 years | 3 | Bilateral apical bullae up to 3 cm | Histology showed pigmented macrophages and DIP-like changes |
| Shah [41] | 1 | 27 | Heavy use for 10 years | 20 | Large left apical bulla and right apical blebs | Normal α1-antitrypsin levels |
| Sood [42] | 1 | 33 | Off and on for 10 years | 15 | VLS on the left side | Normal α1-antitrypsin levels |
| Gargani [43] | 2 | 41 | NA | NA to 39 | One patient had left apical bullae, the other had right upper and middle lobe bullae | In both patients, bullae contained Aspergillus |
| Golwala [44] | 1 | 25 | 24 joint-years | 1 | Bilateral bullae with upper lobe predominance | Previous untreated sarcoidosis but no current clinical/radiological features |
| Tashtoush [45] | 1 | 65 | Heavy use for 20 years | 0 | Bilateral large lung bullae characteristic of VLS | Poorly controlled AIDS and previous intravenous heroin use |
| Fiorelli [46] | 8 | 30 | 7 joints per week to 6 joints per day | 15 to 40 | Eight 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] | 1 | 48 | 86 joint-years | 25 | Bilateral upper and mid zone bullous disease | Sputum grew only Candida, no clinical signs of infection |
| Mishra [48] | 1 | 30 | Daily use for 5 years | None | Spontaneous pneumothorax, apical bullae in the right lung | Normal 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].