title: Recent Marijuana Use and Associations With Exhaled Nitric Oxide and Pulmonary Function in Adults in the United States.
abstract: The medical and recreational use of marijuana is now legal in some parts of the United States; the health effects are unknown. We aimed to evaluate associations between recent marijuana use and exhaled nitric oxide (eNO) and pulmonary function.
  
  
  
  We performed a cross-sectional study of 10,327 US adults participating in the National Health and Nutrition Examination Survey in the years 2007 to 2012. We examined associations between marijuana use and eNO, FEV1, FVC, the FEV1/FVC ratio, and forced expiratory flow (midexpiratory phase) (FEF25%-75%) by weighted linear regression.
  
  
  
  In the study population, there were 4,797 never users, 4,084 past marijuana users, 555 participants who used marijuana 5 to 30 days before the examination, and 891 participants who used marijuana 0 to 4 days before the examination. Current marijuana use in the past 4 days was associated with 13% lower eNO (95% CI, -18% to 8%). FVC was higher in past users (75 mL; 95% CI, 38-112) and current users in the past 5 to 30 days (159 mL; 95% CI, 80-237) and in users within 0 to 4 days of the examination (204 mL; 95% CI, 139-270) compared with never users. All associations remained unchanged and statistically significant in sensitivity analyses excluding current and past tobacco users.
  
  
  
  Current marijuana use was associated with lower levels of eNO and higher FVC. The lower eNO in marijuana smokers suggests that short-term exposure to marijuana may, like tobacco, acutely affect the pulmonary vascular endothelium and impair airflow through the small airways.
authors.affiliation: Cyprus International Institute for Environmental and Public Health in association with the Harvard T. H. Chan School of Public Health, Limassol, Cyprus. Electronic address: s.papatheodorou@cut.ac.cy.
authors.forename: Stefania I
authors.initials: SI
authors.lastname: Papatheodorou
authors.affiliation: Tufts University School of Medicine, Boston, MA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Buettner
authors.affiliation: Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Rice
authors.affiliation: Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
mesh_terms: D000328:Adult; D001944:Breath Tests / Q000379:methods; D002188:Cannabis / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000187:drug effects / Q000378:metabolism; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008168:Lung / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008385:Marijuana Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D009569:Nitric Oxide / Q000032:analysis / Q000378:metabolism; D066232:Pulmonary Elimination / Q000187:drug effects; D013997:Time Factors; D014481:United States
chemical_list: D009569:Nitric Oxide
keywords: exhaled nitric oxide; marijuana; pulmonary function tests
references.citation: J Appl Physiol Respir Environ Exerc Physiol. 1983 Jun;54(6):1618-23
references.pmid: 6874485
references.citation: Arch Intern Med. 2007 Feb 12;167(3):221-8
references.pmid: 17296876
references.citation: Am J Respir Crit Care Med. 2001 Sep 15;164(6):1043-6
references.pmid: 11587994
references.citation: Am J Cardiol. 2006 Aug 15;98 (4):478-84
references.pmid: 16893701
references.citation: J Clin Pharmacol. 2002 Nov;42(11 Suppl):71S-81S
references.pmid: 12412839
references.citation: Ann Allergy Asthma Immunol. 2010 May;104(5):385-93
references.pmid: 20486328
references.citation: Ann Am Thorac Soc. 2015 Feb;12(2):135-41
references.pmid: 25521349
references.citation: Exp Lung Res. 2003 Jan-Feb;29(1):17-28
references.pmid: 12652813
references.citation: J Clin Hypertens (Greenwich). 2008 Apr;10(4):304-10
references.pmid: 18401228
references.citation: J Clin Pharmacol. 2002 Nov;42(11 Suppl):64S-70S
references.pmid: 12412838
references.citation: Pharmacol Biochem Behav. 1991 Nov;40(3):663-9
references.pmid: 1666925
references.citation: Eur Respir J. 2010 Jan;35(1):42-7
references.pmid: 19679602
references.citation: Prog Cardiovasc Dis. 2002 Mar-Apr;44(5):369-80
references.pmid: 12024335
references.citation: Circulation. 2001 Jun 12;103(23):2805-9
references.pmid: 11401936
references.citation: Chest. 1980 Nov;78(5):699-706
references.pmid: 7428453
references.citation: J Appl Physiol. 1976 Oct;41(4):508-16
references.pmid: 985393
references.citation: Am J Respir Crit Care Med. 1995 Aug;152(2):609-12
references.pmid: 7543345
references.citation: Lancet. 2009 Oct 17;374(9698):1383-91
references.pmid: 19837255
references.citation: Physiol Rev. 2004 Jul;84(3):731-65
references.pmid: 15269335
references.citation: Clin Sci (Lond). 2002 Jul;103(1):15-9
references.pmid: 12095399
references.citation: Am J Epidemiol. 2011 Oct 15;174(8):929-33
references.pmid: 21868374
references.citation: Circulation. 2006 Apr 4;113(13):1708-14
references.pmid: 16585403
references.citation: Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):538-51
references.pmid: 7508323
references.citation: Arch Environ Health. 2002 Sep-Oct;57(5):437-40
references.pmid: 12641186
references.citation: Br Med J (Clin Res Ed). 1987 Dec 12;295(6612):1516-8
references.pmid: 3122882
references.citation: Eur Respir J. 2005 Aug;26(2):319-38
references.pmid: 16055882
references.citation: N Engl J Med. 2013 May 30;368(22):e30
references.pmid: 23718175
references.citation: Chest. 2006 Nov;130(5):1319-25
references.pmid: 17099006
references.citation: Am J Respir Crit Care Med. 1997 Jan;155(1):141-8
references.pmid: 9001303
references.citation: Addiction. 2000 Nov;95(11):1669-77
references.pmid: 11219370
references.citation: Eur Respir J. 2010 Jan;35(1):3-5
references.pmid: 20044454
references.citation: Am J Med. 2013 Jul;126(7):583-9
references.pmid: 23684393
references.citation: Int J Cardiol. 2007 May 31;118(2):141-4
references.pmid: 17005273
references.citation: Am J Cardiol. 2014 Jan 1;113(1):187-90
references.pmid: 24176069
references.citation: Phys Ther. 2006 Mar;86(3):345-54
references.pmid: 16506871
references.citation: Eur Respir J. 1994 Mar;7(3):467-71
references.pmid: 8013603
references.citation: J Pharmacol Exp Ther. 2004 Feb;308(2):780-6
references.pmid: 14610231
references.citation: JAMA. 2012 Jan 11;307(2):173-81
references.pmid: 22235088
references.citation: Cardiology. 2012;122(1):55-68
references.pmid: 22722323
references.citation: Lancet. 1994 Jan 15;343(8890):146-7
references.pmid: 7904005
references.citation: J Gen Intern Med. 2005 Jan;20(1):33-7
references.pmid: 15693925
references.citation: Am J Respir Crit Care Med. 2005 Apr 15;171(8):912-30
references.pmid: 15817806
references.citation: Appetite. 1988 Aug;11(1):1-14
references.pmid: 3228283
references.citation: Eur J Pharmacol. 2010 Dec 15;649(1-3):1-13
references.pmid: 20868673
references.citation: Phys Ther. 2011 Jun;91(6):894-905
references.pmid: 21493747
references.citation: Thorax. 2001 Jun;56(6):456-61
references.pmid: 11359961
references.citation: Int J Epidemiol. 1991 Mar;20(1):132-7
references.pmid: 2066211
references.citation: BMJ Open. 2012 Feb 24;2:e000494
references.pmid: 22368296
references.citation: Thorax. 2007 Dec;62(12 ):1058-63
references.pmid: 17666437