UK on verge of steep lung disease rise in young adults - due to heavy spliff smoking?

The UK needs to be prepared for a steep rise in the number of young adults affected by a severe form of lung disease due to their regular cannabis and tobacco use - lung specialists will tell the British Thoracic Society Winter Meeting today (Wednesday 3rd December).

An observational study in Bangor, North Wales analysed patients attending A&E with a severe and accelerated form of emphysema linked to their high use of cannabis and tobacco. Some patients were in their 30s and the whole sample had smoked 5 'joints' a day - or more - for at least a decade.

Eight patients presenting with advanced chronic obstructive pulmonary disease (the umbrella term for a collection of lung diseases including chronic bronchitis and emphysema), aged 35-48 years, were studied by researchers at Ysbyty Gwynedd, a Bangor hospital, over 2 years.

In four cases the lung damage was severe enough to require long term oxygen therapy and one patient is still awaiting a suitable lung transplant.

Researchers believe high cannabis and tobacco use was the major cause of the aggressive and advanced emphysema, independent of any genetic susceptibility, as all the patients had normal levels of the genes alpha 1 antitrypsin and chymotypsin. Deficiencies of these genes can lead to the development of lung disease in some people.

Studies across the globe have also begun to pick up on this advanced and severe emphysema affecting young to middle aged people who use illicit drugs. In Australia smoking cannabis through a bong device, has led to the rise of what experts are now calling 'bong lung.'

Emphysema, a debilitating condition in which the air sacs of the lungs are damaged and enlarged, is mainly caused by tobacco use, and has historically affected people later in life.

Researchers think that the lungs may become damaged more quickly in cannabis users who smoke the drug with tobacco because:

• A 'joint' can often be smoked without a filter - leaving smokers exposed to damaging chemicals from a 'double whammy' of both tobacco and cannabis
• Cannabis smokers tend to inhale for longer - leading to the body retaining more chemical content - increasing the burden of smoke particles and carbon monoxide
• The heavy chemical load is delivered at a potentially damaging temperature
• Modern cannabis is now much stronger with a higher potential for damage

Dr Damian Mckeon, a consultant in respiratory medicine at Ysbyty Gwynedd, and Honorary Senior Lecturer at Bangor University, said:

'We are seeing young people on the wards with the lungs of 80 year olds after less than a decade of smoking cannabis and tobacco.

Our study was in a rural region of North Wales but we believe these cases may represent the tip of the iceberg. There are communities of young people all across the UK, often living in areas of high deprivation and unemployment, who smoke spliffs regularly. They are putting their health and futures in grave danger.

Cannabis is far stronger these days and we are seeing the emergence of a new severe form of emphysema - which could lead to people struggling for breath for the rest of their life. We urgently need a detailed study across the UK which analyses the national picture of cannabis-use and lung disease.'

Dr Bernard Higgins, Chairman of the British Thoracic Society's Executive Committee, and consultant lung specialist at the Freeman Hospital in Newcastle said:

'This study is yet another small but persuasive piece of a jigsaw pointing to a real danger of regularly smoking joints. The Government should monitor this emerging evidence carefully and take it into account when considering future drugs and smoking policy.

We must do all we can to stop lung disease blighting the lives of future generations and an innovative education campaign is key. We also need to ramp up programmes to tackle the underlying reasons behind young people's risk taking behaviour.

We need better data on the national picture, and if hot spot areas can be identified we can then target both NHS services and prevention efforts more effectively.'

Recent UN data shows that cannabis is the world's most widely used illicit drug - and in UK it:

• is the most widely used drug among pupils aged 11-15 years in 2012 with 7.5% reporting they had taken it in the last year
• is also the most commonly used drug among adults aged 16-59, with 6.4% of adults using it in 2012. The next commonly used drug was powder cocaine

Another study presented at the meeting by researchers from the Royal Liverpool and Broadgreen University Hospital Trust, found that people who took illicit drugs such as crack and heroin were nearly 3 times more likely to need emergency hospital treatment to help them breathe (non invasive ventilation) after a worsening of their lung condition - compared with current or ex tobacco smokers.

A further piece of research by the Hospital's research unit (Royal Respiratory Research) found that nearly three quarters of follow up hospital appointments weren't being attended by illicit drug smokers after they'd recently been discharged from hospital after a worsening of their lung condition.

The researchers believe community outreach work could offer a better way to engage with drug-users. A 'one stop shop' approach could encompass advice, services and treatment for both their lung and drug problems - including: a medical review, stop smoking counselling, inhaler technique reviews, medication checks and drug prescriptions.