HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Morris Beshay Ralph A. Schmid Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Beshay, M. Articles by Schmid, R. A. Search for Related Content PubMed PubMed Citation Articles by Beshay, M. Articles by Schmid, R. A. Related Collections Lung - other

Emphysema and secondary pneumothorax in young adults smoking cannabis

^a Division of General Thoracic Surgery, University Hospital Berne, Switzerland
^b Department of Surgery, Otto von Guericke University Hospital, Magdeburg, Germany

Received 2 April 2007; received in revised form 5 July 2007; accepted 23 July 2007.

^_* Corresponding author. Address: Division of General Thoracic Surgery, University Hospital Berne, Berne, Switzerland. Tel.: +41 316 322111; fax: +41 316322327. (Email: ralph.schmid{at}insel.ch).

Background: We observed a remarkable increase in the number of young patients who presented with lung emphysema and secondary spontaneous pneumothorax (SSP) at our institution for over a period of 30 months; most of them have a common history of marijuana abuse. Study design: Retrospective case series. Methods: Seventeen young patients presented with spontaneous pneumothorax with bullous lung emphysema were systematically evaluated over a period of 30 months. All were regular marijuana smokers. Clinical history, chest X-ray, CT-scan, lung function test, and laboratory and histological examinations were assessed. We compared the findings of this group (group I) with the findings of non-marijuana smoking patients (group II) in the same period. The findings of this series were also compared with the findings of 75 patients presented with pneumothorax in a previous period from January 2000 till March 2002 (group III). Results: In group I, there were 17 patients: the median age of the patients was 27 years (range 19–43 years), 16 males and 1 female. All were living in Switzerland. All but one smoked marijuana daily for a mean of 8.8 years and tobacco for 11.8 years. CT-scan showed multiple bullae at the apex or significant bullous emphysema with predominance in the upper lobes only in two patients. Only two patients had reduced forced first second expiratory volume (FEV1) and one reduced vital capacity (VC) below the predicted 50%. This correlated with the subjectively asymptomatic condition of the patients. All but two patients were treated by video-assisted thoracoscopic surgery (VATS) for prevention of relapsing pneumothorax. Histology showed severe lung emphysema, inflammation, and heavily pigmented macrophages. In group II, there were 85 patients: there were 78 males, the median age was 24 years (range 17–40 years), 74 patients smoked tobacco for 13.4 years but no marijuana. CT-scan in 72 patients showed only small bullae at the apex but no significant emphysema; other clinical, laboratory, and histopathological findings showed no significant difference in group I. In group III, there were 75 patients: there were 71 males and 4 females. Mean age was 25 years (range 16–46 years). Six smoked marijuana daily for a mean of 3.2 years, and 62 smoked tobacco for 14 years. CT-scan done in 59 patients showed few small bullae at the apex but no significant lung emphysema. The presence of lung emphysema on CT-scan in group I was significantly different than in groups II and III (p = 0.14). No significant difference was found among all groups in the form of clinical, laboratory, and histopathological findings. Conclusions: In case of emphysema in young individuals, marijuana abuse has to be considered in the differential diagnosis. The period of marijuana smoking seems to play an important role in the development of lung emphysema. This obviously quite frequent condition in young and so far asymptomatic patients will have medical, financial, and ethical impact, as some of these patients may be severely handicapped or even become lung transplant candidates in the future.

Abbreviations: SSP = secondary spontaneous pneumothorax • FEV1 = first second forced expiratory volume • VC = vital capacity • VATS = video-assisted thoracic surgery • CRP = C-reactive proteins

Key Words: Pneumothorax • Cannabis • Lung emphysema

This article has been cited by other articles:

				A. S. Reece Severe multisystem dysfunction in a case of high level exposure to smoked cannabis BMJ Case Reports, September 2, 2009; 2009(sep02_1): bcr0820080798 - bcr0820080798. [Abstract] [Full Text]

				R. A. Schmid and M. Beshay Reply to Fiorello et al. Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 707 - 707. [Full Text] [PDF]

				A. Fiorello, G. Vicidomini, and M. Santini Marijuana smokers and lung bullae Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 706 - 707. [Full Text] [PDF]