Half of Asthma Patients Who Use Cannabis Smoke or Vape, Survey Finds

Grace Halsey

A new survey of patients with asthma who use cannabis finds smoking and vaping preferred routes and that physicians rarely inquire about marijuana use.

Among adults with asthma who use cannabis, half report smoking it and one third report vaping, according to results of a survey published in the Annals of Asthma, Allergy, and Immunology. The survey found in addition that 50% of those with uncontrolled asthma were using it via smoking.

Study authors note that cannabis use is rising as it becomes more widely available through legalization and is sought for its perceived medicinal benefits for symptoms such as pain and anxiety. As is true in many disease populations, use of cannabis among patients with allergy/asthma is not well studied and this despite the risk of significant harm to airways from smoke and vapor inhalation as well as potential for increased use of asthma medications and for disease exacerbations.

In addition to the risk for harm and the dearth of data, the current survey found that "people with asthma are not routinely being asked or advised by their physician about cannabis and how they are consuming it," said Joanna Zeiger, PhD, principal investigator for the study, in an American College of Asthma, Allergy, and Immunology (ACAAI) statement.

To better understand attitudes toward and patterns of cannabis use in this population, authors deployed an anonymous online survey through the patient advocacy group Allergy & Asthma Network. A link to the survey was made available via AAN newsletter and social media postings from May 7 through September 7, 2020.

Of the 873 participants who began the survey, 489 completed it and had useable data. The majority were aged <50 years (60.2%), women (72.4%), White (71.6%), ≥college graduate (71.5%), employed (80.5%), and not obese (69.8%). Alcohol and cigarettes were used in the last month by 63.2% and 4.9% of respondents, respectively.

Among those who completed the survey, 18% reported cannabis use in the past 2 weeks, a frequency authors note that is higher than the general population without medical conditions (8.3%) or with a medical condition (8.8%). Cough related to smoking cannabis was reported by 19.3% of users. Among non-cannabis users, 2.5% reported an allergy to cannabis. Two-thirds of current cannabis users did so for medical or medical/recreational purposes.

Positive effects of cannabis use (eg, reduced pain, calm, improved sleep) were reported significantly more frequently than adverse effects (eg, cough, increased appetite, anxiety).

"Strikingly, among current cannabis users, only about 40% report having their physicians inquire about cannabis use, and about the same number of patients want to discuss cannabis with their physicians," said William Silvers, MD, study co-author, ACAAI member and expert on cannabis allergy in the ACAAI statement.

Study authors write that clinicians are historically reluctant to open these conversations due to poor knowledge of the subject while patients who are receiving benefits from cannabis use feel those outweigh any negative impact on concomitant allergy or asthma.

"In order to more completely manage their allergy/asthma patients, allergists should increase their knowledge about cannabis and inquire about cannabis use including types of cannabinoid, route of use, reasons for use, and adverse effects," said Silvers. "As with cigarette smoking, efforts should be made to reduce smoking of cannabis, and recommend other potentially safer routes such as edibles and sublingual tinctures."

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