The Drug-Induced Respiratory Disease Website and App

Marijuana, cannabis (haschish, hash, bang, dab)

Some adverse effects of marijuana may overlap with those of tobacco smoke. Not all studies confirmed whether marijuana per se is harmful to the airways (PMID 29629404). Variation in cannabis/marijuana/haschich potency, concentration (e.g. resin, hash oil), contamination with fungi (PMID 6348548) and possible adulteration should be considered (PMID:18494838). Reviews at PMID 24831571, 24897085, 25996274, 26935046, 29629404, 29971337. Some users vaporize cannabis using electronic cigarette devices (PMID 30835796)

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.b

Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d

Acute eosinophilic pneumonia (AEP)

I.k

Exogenous lipoid pneumonia (subacute, acute)

I.o

Pulmonary alveolar proteinosis (PAP)

I.u

Pneumoconiosis (silicosis, talcosis...)

I.ao

Hypersensitivity pneumonitis pattern

I.ap

Pulmonary infiltrates

II - Pulmonary edema - Acute lung injury - ARDS

II.e

ARDS - Acute lung injury

III - Pulmonary/alveolar./airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

III.c

Hemoptysis

IV - Airway involvement

IV.a

Bronchospasm - Wheezing - Asthma

IV.ab

Cough (lone)

V - Central-large-upper airway (incl. pharyngeal-nasal) involvement

V.w

Uvulitis, uvular edema

V.ar

Oropharyngeal erosion/bleeding

VI - Pleural and/or pericardial involvement

VI.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

VI.f

Pneumothorax

VI.ac

Pneumothorax, bilateral

VIII - Mediastinal involvement

VIII.h

Pneumomediastinum

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.d

Respiratory failure from ventilatory depression (due to neuromuscular blockade/paralysis)

X - Systemic/Distant conditions, syndromes and reactions

X.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)

X.ae

Anti-GBM antibody disease (Goodpasture-like or flare of preexisting GS)

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent

XI.k

Pulmonary emphysema - Lung cysts or bullae

XI.p

Sniffing death - Death from inhalation of compound

XI.as

Deterioration of graft function in SOT recipients

XII - Cardiovascular involvement / toxicity

XII.c

Pericardial effusion (w/wo tamponade)

XII.d

Myocarditis (can be fulminant)

XII.h

Coronary artery disease (acute) - Myocardial ischemia/infarction

XII.n

Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)

XII.t

Heart block (bundle branch- or AV-)

XII.y

Asystole

XII.ah

Coronary vasospasm - Vasospastic angina

XII.ar

Coronary artery dissection

XVI - Imaging

XVI.m

Imaging: Interlobular septal thickening

XVI.ak

Imaging: A 'tree-in-bud' pattern

XIX - Pathology

XIX.j

Path: Micronodular organizing pneumonia/BOOP

XIX.k

Path: Desquamative interstitial pneumonia (DIP-pattern)

XIX.n

Path: Pulmonary alveolar proteinosis pattern (PAP pattern)

XIX.z

Path: Exogenous lipoid pneumonia

XIX.ab

Path: Foreign body deposits/granulomatous reaction

XIX.ac

Path: Pneumoconiosis (silicosis, talcosis, talcoma)

XX - Infections & related conditions

XX.a

Respiratory tract infection incl. pneumonia

XX.c

Aspergillosis, pulmonary (invasive, allergic [ABPA], or mycetoma)

XX.g

Tuberculosis (pulmonary, pulmonary, extrapulmonary or disseminated). Reactivation or de novo

XXI - Neoplastic conditions

XXI.a

Lung cancer