Objective: To compare clinical course and outcomes in patients admitted for Chronic Obstructive Pulmonary Disease (COPD) who smoke tobacco plus marijuana versus tobacco only.
Methods: Aretrospective chart review was conducted for patients admitted to the Victoria and St Jude Hospitals from January 2014 to June 2016 with a primary discharge diagnosis of Chronic Obstructive Pulmonary Disease (COPD). Select biographic data, self-reported substance use, clinical course and adverse outcomes related to COPD were reviewed. The study was reviewed by the St Lucia Medical and Dental Council Ethics Committee and ethical approval granted.
Results: A total of 100 patient charts were reviewed; 70 patients in the tobacco plus marijuana group and 30 in the tobacco only group. There were significant differences in clinical course and outcomes between the two groups with poorer outcomes noted in tobacco plus marijuana smokers (p < .001). Tobacco plus marijuana smokers required admission for COPD at a younger age (M = 45.4 years, SD = 9.4) compared to tobacco only smokers (M = 72.6 years, SD = 11.6). Tobacco plus marijuana smokers were more likely to be diagnosed with cor pulmonale (OR 15.7, 95% CI 3.47-71.01), which was associated with increased mortality (OR 8.2, 96% CI 3.2-20.8). Lastly, tobacco plus marijuana smokers died at an earlier age, mean age at death 47.6 years (SD = 7.2) versus 73.6 years (SD = 12.8) in tobacco only smokers. Worse clinical outcomes in tobacco plus marijuana smokers were seen despite lower cumulative tobacco consumption; mean of 11.8 pack years (SD = 14.3) versus 34.3 pack years (SD = 29.1) in tobacco only smokers.
Conclusion: Worse clinical outcomes were seen in tobacco smokers who also smoke marijuana. There was an increased risk of admission for COPD at a younger age and more frequent progression to cor pulmonale and death in tobacco plus marijuana smokers despite lower cumulative tobacco consumption compared with tobacco only smokers.
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