humulene and Cough

A 33-year-old man without significant medical history presented to the emergency department with a 6-month history of fatigue and 30 pounds of unintentional weight loss, with a recent cough and fever over the past week. He recalled two similar illnesses during college that did not require medical care. He denied tobacco use but reported inhaling marijuana 1-2 times daily over the past year with a vaping device. Physical exam was notable for a temperature of 100.0°F and an elevated blood pressure at 161/77 mm Hg. He was diaphoretic with clear breath sounds bilaterally. Chest imaging revealed diffuse ground glass opacities with subpleural sparing and mildly enlarged hilar lymph nodes. Bronchoscopy with transbronchial lung biopsies and needle aspirate of lymph nodes revealed organising pneumonia, and subsequent cultures grew

Topics: Actinomycosis; Adult; Cannabis; Cough; Humans; Lung Diseases; Male; Vaping

Topics: Cannabis; Cough; Dyspnea; Humans; Marijuana Smoking; Respiratory Sounds

Cannabis has been demonstrated to have bronchodilator, anti-inflammatory, and antitussive activity in the airways, but information on the active cannabinoids, their receptors, and the mechanisms for these effects is limited. We compared the effects of Δ(9)-tetrahydrocannabinol, cannabidiol, cannabigerol, cannabichromene, cannabidiolic acid, and tetrahydrocannabivarin on contractions of the guinea pig-isolated trachea and bronchoconstriction induced by nerve stimulation or methacholine in anesthetized guinea pigs following exposure to saline or the proinflammatory cytokine, tumor necrosis factor α (TNF-α). CP55940 (2-[(1R,2R,5R)-5-hydroxy-2-(3-hydroxypropyl) cyclohexyl]-5-(2-methyloctan-2-yl)phenol), a synthetic cannabinoid agonist, was also investigated in vitro. The cannabinoids were also evaluated on TNF-α- and lipopolysaccharide-induced leukocyte infiltration into the lungs and citric acid-induced cough responses in guinea pigs. TNF-α, but not saline, augmented tracheal contractility and bronchoconstriction induced by nerve stimulation, but not methacholine. Δ(9)-Tetrahydrocannabinol and CP55940 reduced TNF-α-enhanced nerve-evoked contractions in vitro to the magnitude of saline-incubated trachea. This effect was antagonized by the cannabinoid 1 (CB(1)) and CB(2) receptor antagonists AM251 [N-(piperidin-1-yl)-5-(4-iodophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-caroxamide] and JTE907 [N-(1,3-benzodioxol-5-ylmethyl)-1,2-dihydro-7-methoxy-2-oxo-8-(pentyloxy)-3-quinolinecarboxamide], respectively. Tetrahydrocannabivarin partially inhibited the TNF-α-enhanced nerve-evoked contractions, whereas the other cannabinoids were without effect. The effect of cannabidiol and Δ(9)-tetrahydrocannabinol together did not differ from that of the latter alone. Only Δ(9)-tetrahydrocannabinol inhibited TNF-α-enhanced vagal-induced bronchoconstriction, neutrophil recruitment to the airways, and citric acid-induced cough responses. TNF-α potentiated contractions of airway smooth muscle in response to nerve stimulation by enhancing postganglionic acetylcholine release. Δ(9)-Tetrahydrocannabinol and CP55940 inhibited the TNF-α-enhanced acetylcholine release, and hence contraction and bronchoconstriction, through activation of presynaptic CB(1) and CB(2) receptors. The other cannabinoids did not influence cholinergic transmission, and only Δ(9)-THC demonstrated effects on airway hyper-responsiveness, anti-inflammatory activity, and antitussive activity in the airways.

Topics: Airway Resistance; Animals; Bronchoalveolar Lavage Fluid; Bronchoconstriction; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Citric Acid; Cough; Cyclohexanols; Guinea Pigs; Inflammation; Isometric Contraction; Lipopolysaccharides; Male; Muscle, Smooth; Respiratory Hypersensitivity; Respiratory System; Trachea; Tumor Necrosis Factor-alpha

Smoking cannabis is associated with symptoms of bronchitis. Little is known about the persistence of symptoms after stopping cannabis use. We assessed associations between changes in cannabis use and respiratory symptoms in a population-based cohort of 1037 young adults. Participants were asked about cannabis and tobacco use at ages 18, 21, 26, 32 and 38 years. Symptoms of morning cough, sputum production, wheeze, dyspnoea on exertion and asthma diagnoses were ascertained at the same ages. Frequent cannabis use was defined as ≥52 occasions over the previous year. Associations between frequent cannabis use and respiratory symptoms were analysed using generalised estimating equations with adjustments for tobacco smoking, asthma, sex and age. Frequent cannabis use was associated with morning cough (OR 1.97, p<0.001), sputum production (OR 2.31, p<0.001) and wheeze (OR 1.55, p<0.001). Reducing or quitting cannabis use was associated with reductions in the prevalence of cough, sputum and wheeze to levels similar to nonusers.Frequent cannabis use is associated with symptoms of bronchitis in young adults. Reducing cannabis use often leads to a resolution of these symptoms.

Topics: Adolescent; Adult; Bronchitis; Cannabis; Cough; Female; Follow-Up Studies; Humans; Male; Marijuana Smoking; New Zealand; Prevalence; Respiration; Respiration Disorders; Respiratory Sounds; Smoking; Surveys and Questionnaires; Tobacco Use Disorder; Young Adult

Cannabis is widely smoked in Europe and its increasing use is becoming a major public health problem. Adulterating cannabis with glass beads or sand is a new trick used by dealers to increase the weight and boost profits. These recent practices are not without danger. We report two cases of respiratory symptoms related to the use of this kind of adulterated cannabis. The first case is a 33 year-old patient admitted for an acute inhalation pneumonitis secondary to smoking cannabis adulterated with grit sand. The CT scan showed patchy ground-glass opacities, mainly in the upper lobes. A broncho-alveolar lavage, examined under polarized light, revealed birefringent intracellular particles, identified as silica, in alveolar macrophages. Spontaneously clinical and radiological improvements were observed after stopping the use of contaminated cannabis. The second patient, who smoked cannabis mixed with glass beads, described epistaxis, mouth ulcers, sore throats and cough. CT scan and BAL were normal. Adulteration of cannabis with microscopic glass beads, alone or mixed with sand, is a recent and widespread practice in Europe. These anecdotal reports prompted the French Department of Health to advise cannabis smokers of the harmfulness of these contaminants.

Topics: Adult; Cannabis; Cough; Drug Contamination; Epistaxis; France; Humans; Inhalation; Male; Oral Ulcer; Pharyngitis; Pneumonia; Radiography

A 3-year follow-up study was performed on 38 women and 28 men from the originally studied textile workers employed in a soft hemp processing mill. Acute and chronic respiratory symptoms and ventilatory capacity were recorded during the cross-sectional and the follow-up studies. Maximum expiratory flow-volume (MEFV) curves were obtained on these workers, and forced vital capacity (FVC), 1-second forced expiratory volume (FEV1) and flow rates at 50% and at 25% of the VC (FEF50, FEF25) were measured. High prevalences of acute and chronic respiratory symptoms persisted at the follow-up study. In particular, high prevalences of byssinosis were documented at both studies (women: 47.4% and 47.4%; men: 64.3% and 67.9%, respectively). Statistically significant mean across-shift reductions were recorded for all ventilatory capacity tests at the initial study. A large mean annual decline was calculated for FEV1 in women and for all ventilatory capacity parameters in men; these declines were greater for workers with symptoms of byssinosis than for those without. The accelerated decline in FEV1 noted in the women workers, who were predominantly nonsmokers, suggests an independent hemp effect. Exposures in the work environment were measured with Hexhlet filters and revealed very high dust concentrations (mean total: 21.4 mg/m3, 22.4 mg/m3; respirable: 8.4 mg/m3, 9.9 mg/m3) at both initial and follow-up studies. These levels are much higher than those found in mills processing organic materials in North America. Our data demonstrate that work in the hemp industry, particularly in small poorly regulated mills, continues to have deleterious effects on respiratory function.

Topics: Adult; Air Pollutants, Occupational; Asthma; Byssinosis; Cannabis; Cohort Studies; Cough; Cross-Sectional Studies; Dust; Dyspnea; Female; Follow-Up Studies; Forced Expiratory Volume; Humans; Lung Diseases; Male; Middle Aged; Occupational Diseases; Smoking; Textile Industry; Vital Capacity

Experimental cough was elicited in pentobarbital-anesthetized cats by either electrical stimulation of the superior laryngeal nerve or by mechanical stimulation of the tracheal mucosa. Intravenous administration of delta9-tetrahydrocannabinol (THC) effectively reduced the amplitude of the cough response in both these models of experimentally induced cough with ED50 values (AtD50) of 1.84 and 0.78 mg/kg, respectively. This cough suppressant activity of THC was more similar to codeine-PO4 than dextromethorphan-HBr. On the other hand, both cannabinol (CBN) and cannabidiol (CBD) were devoid of antitussive activity at doses as high as 10.0 mg/kg.

Topics: Animals; Antitussive Agents; Cannabidiol; Cannabis; Cats; Codeine; Cough; Dextromethorphan; Dronabinol; Electric Stimulation; Female; Injections, Intravenous; Laryngeal Nerves; Male; Physical Stimulation; Phytotherapy; Respiration; Trachea

Topics: Byssinosis; Cannabis; Chronic Disease; Cough; Dust; Dyspnea; Female; Humans; Male; Respiratory Function Tests; Spirometry; Textile Industry