Cannabis Use Linked to Fewer Acute Exacerbations of COPD

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How does cannabis affect COPD? To determine this, researchers assessed the risk for acute exacerbations of COPD in those who used cannabis vs those who did not.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) appear to be significantly less likely in those who use cannabis, according to research presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held October 16 to 19, in Nashville, Tennessee.

Although cannabis use is rising, its effect on patients with COPD has not been studied.

Researchers therefore sought to evaluate the odds of AECOPD in 2 groups of patients hospitalized for COPD: those with cannabis use disorder (CUD), and those with no known history of cannabis use. Primary endpoints were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE; ie, stroke, cardiac arrest, and acute myocardial infarction).

Using data in the 2018 National Inpatient Sample, investigators identified patients with AECOPD who had CUD (CUD+; n=7050) and compared their baseline characteristic, comorbidities, and inpatient outcomes to patients hospitalized with AECOPD with no known history of CUD (CUD-). Researchers noted a significantly lower prevalence of AECOPD in the CUD+ cohort (8.8%) vs CUD- cohort (16.5%).

The decreased risk of AECOPD with cannabis use was confirmed with regression analysis, both unadjusted (OR 0.49; 95% CI, 0.45-0.53) and adjusted for sociodemographic factors (OR 0.79; 95% CI, 0.74-0.84], as well as adjusted for both sociodemographic factors and comorbidities (OR 0.71; 95% CI, 0.67-0.76) (P <.001).

In comparing those who used cannabis vs those who did not, the researchers found that patients in the COPD-CUD+ cohort were more likely to be male (60.7% vs 46.6%), Black (27.4% vs 11.8%), and younger (57 vs 70 years) (P <.001). Patients in the COPD-CUD+ cohort vs COPD-CUD- cohort were also more often admitted to urban teaching hospitals (67.6% vs 59.5%; P <.001), admitted nonelectively (96.2% vs 95.6%; P =.01), enrolled in Medicaid (39.4% vs 11.3%; P <.001), and categorized as low-income (48.3% vs 35.9%; P <.001).

The investigators also observed a lower rate of traditional cardiovascular disease risk factors in the COPD-CUD+ cohort; however, patients in this group had a greater incidence of liver disease, mental health disorders, and substance abuse (P <.001) than those in the COPD-CUD- cohort.

No significant association on multivariable regression analysis was found between CUD and MACCE (OR -1.18; 95% CI, -0.97 to 1.44; P =.092) or CUD and all-cause mortality (OR 0.85; 95% CI, 0.58-1.23; P =.385) in patients admitted for AECOPD. Compared with the COPD-CUD- cohort, the COPD-CUD+ cohort had shorter hospital stays (4 vs 5 days) and lower hospital costs ($9649 vs $10,424) (P <.001).

The researchers concluded that “Cannabis use disorder may have a protective effect with a decreased likelihood of acute exacerbations by about 30% in COPD patients, without a significant effect on subsequent all-cause mortality and MACCE.” Further prospective studies are needed “to explore the association and potential therapeutic use of medicinal cannabis in COPD to decrease exacerbations” as well as the “effects of recreational use of marijuana on COPD outcomes that frequently lead to hospitalizations and increase healthcare cost.”


Desai R, Baraskar B, Kumar J, et al. Paradoxical effect of cannabis use on COPD exacerbations: A nationwide analysis. Presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN. Abstract Poster 88A.