This article is excerpted from Medical cannabis: pearls for clinical practice by dr. Deborah Malka Courtesy of Convention on the Rights of the Child Press, an imprint of Taylor & Francis group. Copyright © 2022, Deborah Malka MD Ph.D.
Cannabis has been used historically as a treatment for asthma dating back to the 19th century, indicating benefits and risks for this group of patients.1 Although smoking in general is not a good idea for anyone with asthma, smoking cannabis has not been shown to be as harmful as expected.
A 2006 study of 1,200 participants showed that even heavy marijuana smoking was not linked to lung cancer and other types of upper gastrointestinal cancers.2 This finding was confirmed by a subsequent report in International Journal of Cancerwhich concluded: “The results of our pooled analyzes provide little evidence of an increased risk of lung cancer among habitual or long-term cannabis smokers.”3
A review of the scientific literature found that short-term cannabis smoking is associated with bronchiectasis. In the 1970s, cannabis was shown to reverse exercise-induced asthma and hypertrophy.4 Initial reports of an association between long-term cannabis smoking and an increase in respiratory symptoms indicative of obstructive pulmonary disease were subsequently found to be unsubstantiated.5
It is important to keep in mind that cannabis may be a precipitating factor in acute asthma and allergy attacks. Several papers have shown an association between marijuana use and an increase in asthma and other allergic disease symptoms, as well as an increase in the frequency of medical visits.6 But this only applies to cannabis smoking and has not been shown in alternative delivery methods.
tetrahydrocannabinol (THC) has long been known to be an effective bronchodilator. This was demonstrated in a 1978 study of humans at low doses, 100-200 mcg, delivered via a nebulizer inhaler. Maximum improvement was seen at about 60 minutes and lasted for at least 3 hours, with forced expiratory volume improvement lasting more than 6 hours after dosing.7
While most studies of cannabis and asthma have focused primarily on the effect of bronchiectasis, some have also noted a reduction in bronchitis.89 This is not surprising given that cannabis is well known for its anti-inflammatory effects. Recent large studies have shown that instead of reducing forced expiratory volume and forced vital capacity (FVC), cannabis smoking is associated with an increase in FVC. The reason for this is unclear, but the acute bronchodilator and anti-inflammatory effects of cannabis may be related.10
2014 report in British Journal of Pharmacology demonstrated that this effect is mediated by the endocannabinoid system. activation CB1 Cannabinoid receptors inhibit bronchial motor tone.11 And the CB2 The receptors are thought to be involved in neuroinflammatory mechanisms that act through sensory nerves, and thus have potential therapeutic value for allergic asthma.12
THC & Convention on Biological Diversity
Both THC and cannabidiol (Convention on Biological DiversityAnti-inflammatory and muscle relaxant. But unlike many health claims for value Convention on Biological DiversityIt’s not a bronchodilator. A study of the effect of several cannabinoids on lung function (in animals) showed significant differences between them. THC and tetrahydrocannabivarin (THCV), for example, prevents induced tracheal contractions, while Convention on Biological Diversity did not. THC He did better than Convention on Biological Diversity in suppressing cough. Some researchers have suggested that a combination of Convention on Biological Diversity And the THC It may reduce swelling in the lungs and help open the airways in people with COPD (chronic obstructive pulmonary disease).13
Smoking anything, of course, is dangerous for those with respiratory ailments. A survey of tobacco and cannabis smokers found that cannabis smokers had no more chronic obstructive pulmonary disease or more respiratory symptoms than non-smokers, but smoking both tobacco and cannabis increases the risk of respiratory symptoms and chronic obstructive pulmonary disease.14
Fumigation is a preferred method of delivery because it provides a direct medicinal action to the lungs when inhaled without harmful smoke. Results from the few studies that attempt to isolate the respiratory risks associated with vaporizers show some level of benefit.15th A 1975 report indicated that inhaling high doses (20 mg) of a nebulizer THC It can be irritating for people with asthma.16 Conversely, the acute effects of vaporized cannabis on airway function in adults with advanced chronic obstructive pulmonary disease No harm was shown again, high doses were used. In another study, the effect of 35 mg evaporated THC– Rich cannabis has not been shown to have any positive or negative effect on airway function, exertional dyspnea, and exercise endurance in adults with advanced conditions. chronic obstructive pulmonary disease.17
Vaporized cannabis may have a beneficial effect on shortness of breath and exercise performance in symptomatic patients chronic obstructive pulmonary disease. More research is needed in this area. Larger randomized clinical trials with a broader study group including patients with less advanced symptoms are needed chronic obstructive pulmonary disease.18
Cannabis itself can provide increased benefit beyond the effects of cannabis, due to the selection of cultivars with specific terpene content. For example, α-pinene helps with bronchiectasis and β-myrcene helps with muscle relaxation. Fumigation of the whole plant cannabis flower with suitable terpene forms may produce the most positive results.
Selected patient reports
Patient A: A 36-year-old man with asthma who had already been a patient with medical cannabis for one year reported that fumigating an entire hybrid strain of Sativa twice daily allowed him to stop taking Advair. He was still taking Singulair daily with rare use of an albuterol inhaler. He preferred cannabis to Advair because he was a proponent of natural medicines. He stopped tobacco 1 year ago, so the decreased need for Advair may be due to improved lung function. On our last visit, I was advised to look for a strain rich in α-Pinene as the effect of terpenes is now more well known.
pearls: One would think that cannabis replaced Advair in this patient, although his condition would likely have improved due to discontinuation of tobacco use. It is not clear to what extent cannabis vaporization was instrumental in making this transition. I haven’t found it mainstream that steaming a small amount of cannabis, twice a day, is as effective as the medications in most asthmatics.
Patient B: A 72-year-old woman with severe asthma and severe back pain due to scoliosis and adult-onset diabetes was new to cannabis use. Her medications included Singulair, Spiriva, Arcapta, Pulmocort, and Brovana nebulizers for asthma, as well as diabetes medications, but no pain medication. She reported that spinal injections did not help with back pain. She has been using the cane to move around for 5 years, due to the curvature of her spine, causing pain in her shoulder. started in Convention on Biological Diversity/THC 1:1 tincture, 10 mg used every night and sometimes during the day. Her medication hadn’t changed, but her back felt better. She continued at this dosage for several years and also added topically for joint pain. Your asthma medications remain the same.
pearls: This patient was in severe pain, but wanted to avoid opiates because of their negative effect on the weakened respiratory system. She found relief with cannabis, without any risk of developing advanced asthma. Unfortunately, her asthma did not improve, but it was not exacerbated by this non-smoking cannabis treatment.
Patient C: A 74-year-old woman, who suffered from insomnia and high blood pressure chronic obstructive pulmonary diseaseHe has been using cannabis for the past several years as a medical cannabis patient. She had a history of tobacco use, but stopped 5 years ago. She was also using multiple inhalers, including Spiriva, Asmanex, and nebulizers. She advised her to use cannabis by tincture or edible, about 5 mg 2 x / day, which allowed her to discontinue Trazodone and Diovan. She said the blood pressure medication contributed to her “gasping for air” and she felt better.
pearls: This case is an example of a patient who has chronic obstructive pulmonary disease Who can benefit from cannabis? in cases chronic obstructive pulmonary diseaseWe do not expect to see a significant positive or negative effect on lung function with cannabis use. This patient was able to stop taking high blood pressure and insomnia medications, but not for chronic obstructive pulmonary diseasealthough relaxation and better sleep contributed to an improved quality of life.
Cannabis treatment summary
Cannabis delivery for respiratory ailments should be chosen wisely. While tinctures and nutrients pose no danger, it is possible that certified hemp that is free of mold, pesticides, and solvents delivered through a complete flower vaporizer is most effective for such patients. On the rare occasion a patient was using cannabis primarily for asthma relief, my advice was to use whole flower from a strain rich in α-Pinene. I actually ask patients to smell the flowers in the dispensary and choose one with a pine scent.
Vaporizer pens should be avoided because oil extractors tend to be deficient in turbines and because not all brands are free of petrochemical residues. There are some newer dose inhalers containing cannabis and select terpenes that have recently become available. Those with α-Pinene would be excellent at treating asthma, as they may cause bronchiectasis. An inhaler has been marketed containing 6.5-7 mg THC And 1-2 mg of terpenes in each exchange. When vapor inhalers become more widely available, these will be my first choice for asthma relief.
Cannabis is not usually used for treatment chronic obstructive pulmonary diseaseBut it is good to know that it does not only harm patients chronic obstructive pulmonary diseasebut may in fact increase its coercive vital capacity (FVC). In some cases, the muscle-relaxing properties of cannabis, especially varieties that contain β-myrcene, can relax chest wall and diaphragm spasms. usually, THC– Rich cannabis is used to expand the bronchi so far Convention on Biological Diversity– Products containing it help relax muscles and reduce inflammation in cases of atopic respiratory disease.