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Marijuana and Asthma

by Emily Earlenbaugh, PhD.

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Medical Marijuana for Asthma

You might instinctively assume marijuana causes asthma, but there are actually many documented cases of smoked cannabis being able to halt ongoing asthma attacks. There is also evidence suggesting that the endocannabinoid system plays an important role in the activity of the respiratory system, and can even modulate that activity in a number of ways. 

In addition, both preclinical and clinical research shows that cannabis has the potential to aid with asthma treatment as a bronchodilator. However, the studies that have been done on the full effects of cannabis and asthma were either limited in scope or conducted on animals. More research is needed to confirm whether cannabis can be helpful for asthmatics. If you are considering trying cannabis to help your asthma, you should first consult a doctor who specializes in cannabinoids.

In terms of the best strains of marijuana to treat asthma, you can narrow down the possibilities by looking at strains that are high in the terpenes pinene, limonene or eucaliptul, according to the research. 

Medical Studies on Marijuana and Asthma

Given that marijuana can interact with the endocannabinoid receptors in our lungs, can it treat asthma? Many researchers have wondered the same thing, and set out to study how cannabis impacts this condition. There was some concern that cannabis smoke would act like tobacco smoke, and add to the risk factors for asthma. As it turns out, the research suggests that cannabis is a fairly reliable bronchodilator. In other words, it is able to open up the airways that are constricted during an asthma attack. This is in stark contrast to the smoke from tobacco, which is a noted bronchoconstrictor. Tobacco smoke can close airways up, actually triggering asthma attacks.

Studies on smoked marijuana that includes low levels of THC (1-2.6%) have found that cannabis can act as a bronchodilator. One study found that it was able to halt bronchospasm and associated hyperinflation of the lungs almost immediately. Another study also found cannabis smoke caused bronchodilation — with more pronounced effects when using more THC — and noted that it did not come along with any central respiratory depression. While this research is promising, both of these studies were limited by a relatively small sample size. They also both utilized cannabis with much lower levels of THC than are found in most available strains of marijuana. Future research might investigate more common chemotypes of cannabis, or THC alone, to find out how these influence lung function.

Overall, the research does support the idea that cannabis can help treat asthma as a bronchodilator, and potentially even help in other ways. Still, more research is needed to confirm and better understand these findings. If you are considering using cannabis for your own asthma, make sure to consult a physician who specializes in cannabinoid treatments to find out if it could be right for you.

CBD and Asthma 

Some studies have also focused on CBD’s effects on asthma. These studies have also been promising — if limited — since they relied on animal models of asthma. For example, in rodent models of asthma, CBD was able to reduce airway inflammation and the damage and scarring to lung tissue associated with asthma. Similarly, guinea pig models of asthma showed that CBD was able to help reduce airway constriction. Researchers on both studies believe that CBD could be beneficial for treating this condition, but human studies are needed to confirm these findings.

Terpenes and Asthma

In addition to these two cannabinoids, which show potential for aiding asthma, one of the cannabis terpenes (the chemicals in cannabis which gives it flavor, aroma, and a wide range of pharmacological effects) may also be able to help. Eucalyptol is a terpene present in many strains of marijuana (although not all), and it is also present in some other plants like the Eucalyptus tree. Studies on eucalyptol show that it can also be helpful for treating airway inflammation. In one study asthma sufferers taking eucalyptol supplements saw a significant decrease in asthma related symptoms. In another study, those taking eucalyptol were able to reduce the other asthma medications they were taking as a result of their eucalyptol treatment. 

Limonene, one of the major terpenes in marijuana, has also shown potential benefits for asthma. One 2010 study found that limonene may have potential anti inflammatory efficacy for the treatment of bronchial asthma…”

Pinene, another very prevalent terpene in marijuana, and very common to conifers, has also shown bronchodilator effects.

How Does Marijuana Affect Asthma 

When it comes to understanding how marijuana works to treat asthma, we first need to understand how cannabis works in general. Cannabis interacts with our bodies primarily through the endocannabinoid system — which maintains homeostasis or balance for many key functions such as sleep, hunger, mood, immune response, and memory. This important system in the human body is made up of three parts, endocannabinoids, receptors and enzymes. 

Endocannabinoids are natural chemicals produced by the body. These activate or modulate the endocannabinoid receptors (such as CB1 and CB2 receptors) to trigger the system’s balancing effects. Enzymes then metabolize the endocannabinoids and clear them from the body. 

While endocannabinoids usually activate this system, it can also be triggered by the cannabinoids found in the cannabis plant. These chemicals are also able to interact with the endocannabinoid system, and thus impact many of it’s important functions. This is how cannabis is able to impact the human body in so many noticeable ways. 

These endocannabinoid receptors are located in many parts of the human body, and as it turns out, this includes the lungs. In fact, almost every cell type present in the human lungs expresses an endocannabinoid receptor. Both CB1 and CB2 receptors can be found in the lungs and in the bronchial tissue — with CB1 levels being significantly higher than CB2. This suggests that the lungs are susceptible to the effects of the endocannabinoid system, and thus can be affected by cannabis. 

In studies looking at the effects of cannabinoids and endocannabinoids on these receptors, it has been shown that they can be potent anti-inflammatory agents. This could help to explain why we see many studies and accounts of cannabis (or its most common ingredients THC and CBD) acting as a bronchodilator, opening up airways and reducing mucus production.

Best Marijuana Strains for Asthma

There are thousands of marijuana strains out there, and choosing the best one for you can be a complicated endeavor. Looking at the body of evidence we can see that THC and CBD could be effective for asthma, even in very low concentrations (1-3% THC). The terpenes eucaliptul, limonene and pinene could also alleviate some of the symptoms of asthma, and the entourage effect theory that suggests a potential synergy between cannabinoids and terpenes even suggest some of these terpenes could potentiate the effects of THC and CBD. If your physician and you decided to try marijana treatment for your asthma, you should look for chemovars (AKA strains) high in these cannabinoids and terpenes. In case you live in a state where there’s an active marijuana program, you could ask for the Certificate of Analysis (CoA) of the product you’re considering in order to examine the main cannabinoids and terpenes in it.

If you prefer avoiding the high associated with THC, you can look for chemovars like Ringo’s Gift, that are high in CBD and have both pinene and limonene. If you have any concerns about smoking marijuana, you can try other delivery methods, such as vaporizers, inhalers, tinctures or edibles. Some of the knowledge about these compounds is based on preliminary research, and though they are all generally recognized as safe (GRAS) by the FDA, you should consult with your treating physician before trying marijuana for asthma.

Side Effects of Marijuana for Asthma

While some asthma sufferers report big improvements using marijuana for their asthma, it is not without the risk of side effects. In general, the side effects of marijuana can include temporary shifts in cognitive function, coordination and memory, dry eyes and mouth, increased heart-rate, and anxiety or paranoia. For most, these are rare, mild, or manageable, but for some they pose limits to functionality that make cannabis a less effective treatment.

Cannabis Side Effects

Perhaps the most important side effect for asthma sufferers to consider is the allergies that cannabis can cause itself. In mild cases, cannabis allergies can cause increased congestion, runny nose, watery eyes, post-nasal drip, and itchy eyes or nose. These could be distressing to asthma sufferers and potentially harmful for those who suffer from asthma which is triggered by allergies. In more serious cases, people report skin rashes from contact with cannabis resin, worsening asthma symptoms, or even anaphylactic shock. If you have an allergy to cannabis, it may not be a helpful treatment for your asthma. 

Some also point to marijuana smoke’s potential to negatively impact the lungs as a negative side effect. Animal studies suggest that cannabis smoking correlates to changes in lung cells and lung diseases like bronchiolitis. Still, a 20-year longitudinal study on smoked cannabis in humans found no evidence that it’s use correlates with increased lung disease or decreased pulmonary function. In fact, this research suggests that it may actually increase pulmonary function for some cannabis users. 

Since asthma can be a life-threatening condition, it is best to work with an MD who has experience treating asthma with marijuana, and can help assist with any negative side effects that might arise.

Disclaimer

The Cannigma content is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with an experienced medical professional with a background in cannabis before beginning treatment.

About Asthma

Overview

Asthma is a long-term inflammatory disease of the airways of the lungs in which the airways narrow, swell, and produce mucus. The result is difficulty in breathing, which causes wheezing, coughing and shortness of breath. 

If you had a hard time breathing once or twice in your life, that doesn’t necessarily mean that you are suffering from asthma. However, if you started having these difficulties at a very young age, or felt that they are endangering your life, it is best to consult a doctor as soon as possible. 

While most cases of asthma are mild and relatively easy to control, the most severe form of asthma episode is known as an “attack” and it may occur several times in a day or a week. The difficulty in breathing can also make physical exercise difficult to extremely difficult for some asthma patients, and may also become worse at night. 

There are generally five known types of asthma:

  • Allergic Asthma – in which symptoms get worse due to exposure to specific allergens, especially airborne
  • Asthma-COPD Overlap – in which chronic obstructive pulmonary disorder (or COPD), another inflammatory disease that causes airflow blockage, overlaps with asthma
  • Exercise-Induced Bronchoconstriction (EIB) – in which symptoms develop when airways narrow as a result of physical activity
  • Nonallergic Asthma – in which asthma symptoms flare up as a result of nonallergic causes, like weather conditions
  • Occupational Asthma – in which the symptoms occur when the sufferer is exposed to chemical fumes, gases, dust or other substances in the workplace

Several additional health conditions occur more frequently in patients with asthma. These include gastroesophageal reflux disease (GERD), obstructive sleep apnea, and rhinosinusitis, as well as psychological disorders. A reported 16-52 percent of Asthma patients have anxiety disorders and 14-41 percent report mood disorders.

The Centers for Disease Control and Prevention (CDC) estimates that 27 million Americans suffer from asthma, as well as one in 12 children.

Symptoms

Asthma is the most common chronic disease among children and its symptoms usually appear around five years of age. The wheezing and difficulties in breaking are usually a result of regular infections caused by respiratory viruses. 

However, not everyone with asthma will experience the same symptoms. The first indication for asthma may not be an actual asthma attack, but rather a difficulty in breathing while exercising. The symptoms also differ depending on the cause of the disease and its triggers. For example, a person who inherited the disease won’t have the same symptoms as a person with allergies.

 The most common symptoms of asthma include:

  • Coughing – during exercise, at night or while laughing
  • Shortness of breath
  • Making sounds when trying to breathe – like a squeak or a whistle 
  • Tightness in the chest
  • Fatigue

These symptoms can result in other health problems, such as sleep disturbances caused by breathing difficulties. Other causes of breathing difficulties, such as cold or flu, can also aggravate asthma symptoms. 

Some environmental causes are also known to trigger asthma symptoms. If you have difficulty in breathing, whether or not it’s caused by asthma, it is recommended to avoid:

  • Irritants such as chemical fumes, gases or dust – especially in the workplace
  • Airborne substances, such as mold spores or particles of skin and dried saliva shed by pets that may trigger allergies

Causes

The truth is there are many factors, from genetic makeup to environmental causes, that can contribute to the development of asthma. One of them is allergies. A study from 2013 found a strong link between asthma and allergies, stating that over 65 percent of adults with asthma, over the age of 55, also have an allergy. Among adults between the ages of 20 and 40, the figure is closer to 75 percent. Common sources for allergens include animal proteins, as well as dust mites and fungi.

Other than being exposed to allergens and other risk factors via pollution, weather conditions or workplace environment, smoking tobacco may trigger asthma. Smoking worsens the symptoms of asthma by adding coughing, breathlessness, and overproduction of mucus. According to research, these factors not only increases the risk of asthma and respiratory infections but also death. Even the children of parents who smoke have a higher risk of developing asthma.

Researchers also point out these risk factors that may trigger asthma:

    • Genetics – a child to an asthmatic parent has a 25 percent chance of developing the condition. Having two parents with asthma increases the risk to 50 percent.
    • Atopy – people with this kind of allergic hypersensitivity are prone to allergic reactions, in which the body produces more immunoglobulin (IgE) antibodies than needed and triggers asthmatic symptoms.

 

  • The menstrual cycle – in perimenstrual asthma (PMA), the hormones that circulate during menstruation trigger an immune action that can cause hypersensitivity in the airways.

 

  • Smoking during pregnancy – women who smoke during pregnancy may experience complications during labor and delivery, as well as decreased fetal growth. Newborns may also suffer from asthma if exposed to tobacco toxins via the placenta while in utero.  
  • Stress – high levels of stress increase the chance of asthma, also because people suffering from stress sometimes smoke in order to relax. However, stress levels may sometimes increase due to trauma or laughter, thus triggering asthma development.

Obesity – some reports link between obesity and asthma, while others suggest the inflammatory mechanism that causes asthma also leads to obesity.

Diagnosis

If your doctor suspects the reason for the breathing difficulty is asthma, he/she will ask about your medical history, focusing on childhood. Afterward, there will be a physical exam to test the lungs in action. The test will include: 

  • Spirometry – a simple test measuring how much air you can blow out and at what speed 
  • Peak flow – you can even perform this test at home using a peak flow meter to see how much air your lungs can push out 
  • Methacholine challenge – this test is performed mostly on adults if there are no clear results from the previous two tests. In this test, you’ll be asked to inhale increasing amounts of methacholine mist, before and after completion of the spirometry test. This test will end in medication to reverse the effects of methacholine, such as headache, nausea, vomiting or dizziness.
  • Exhaled nitric oxide test – a test measuring the amount of nitric oxide in your breath. If the airways are inflamed, the reading may be high

Other possible tests include:

  • Chest X-ray– This test might be required to rule out other possible causes for the asthma symptoms 
  • Computerized tomography (CT)- this test features a series of X-rays to create a holistic view of the inside of the body. It will mostly focus on lungs and sinuses to identify any possible structural problems or diseases (like an infection)
  • Allergy tests – blood and/or skin tests can be used to identify the source of the allergy
  • Sputum eosinophils – This test focuses on the mix of saliva and mucus that comes out when coughing to look for high levels of white blood cells 

These tests can also help health care professionals rule out other diseases that cause similar symptoms like gastroesophageal reflux disease (GERD), sinusitis, airway tumors, bronchitis, vocal cord dysfunction, and congestive heart failure. A visit to a specialist might also be required if the patient shows severe symptoms or might need more than one medication, for allergies or any other associated conditions.

After administering the tests, the care physician will diagnose the type of asthma causing the symptoms, and determine the level of asthma as mild, intermittent, moderate, or severe.

Treatment

Take a deep breath: there is no cure for asthma, but there are ways to control the symptoms with early diagnosis and treatment. This normally consists of taking medications and using inhalers, if necessary, while avoiding triggers that worsen asthma symptoms. 

In some cases, you will be advised to combine inhaled corticosteroid with a long-acting beta-agonist (LABA), a symptom-controller that helps in opening airways. However, the use of LABA might be considered dangerous in certain circumstances, such as unsupervised “off-label” treatment in patients whose condition is unstable.

Another way of treating severe asthma is biologics, which are personalized injections or fusions that are meant to help in dealing with asthma regularly. This kind of treatment is not suited to every type of asthma, and further blood tests might be required to determine the relevancy of the treatment for the patient’s condition. 

In addition to the medical treatment, it is recommended to maintain a healthy lifestyle to reduce the chances of an asthma attack. This can be done by:

  • Eating a healthy, balanced diet 
  • Exercising regularly – even though exercise can trigger asthma symptoms, it can also reduce the risk of breathing problems
  • Avoiding obesity by maintaining a healthy weight
  • Quitting smoking
  • Managing stress

If you are an asthmatic woman, it’s important to know that you should continue the treatment of asthma during pregnancy. Symptoms of asthma might worsen, in some cases, during the second and third trimesters. If left untreated, this can result in complications like pregnancy-induced high blood pressure, preeclampsia, and even preterm labor. Furthermore, babies who are not getting enough oxygen might experience health complications of their own.

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