Allergy & Asthma Network and Joanna Zeiger, PhD, hosted a Twitter chat on June 11 on cannabis (marijuana) use and its impact on people with asthma, exercise-induced bronchospasm, allergies, eczema and urticaria. As part of the Allergy & Asthma Network Pain, Exercise and Cannabis Experience (PEACE) survey, Dr. Zeiger answered questions during the Twitter chat that are summarized here for you. Dr. Zeiger is CEO and researcher with Canna Research Group, an organization seeking to better understand how people are using cannabis to manage medical conditions.Dr. Zeiger is also a former U.S. professional triathlete who was the 2008 Ironman 70.3 World Champion and competed at the 2000 Sydney Olympics where she placed 4th in triathlon. She is the author of “The Champion Mindset – An Athlete’s Guide to Mental Toughness.”
Questions and answers about cannabis (marijuana) use for asthma, allergies, eczema and exercise-induced bronchospasm (EIB)
What are the natural compounds found in cannabis?
- THC – tetrahydrocannabinol. THC is the compound in cannabis that is psychoactive and gives the “high” sensation. It’s consumed by smoking and in oils, edibles, tinctures and capsules.
- CBD – cannabidiol. CBD is the cannabinoid that is associated with anti-inflammatory and immune modulating properties, and is not psychoactive, so it does not typically provide a “high” sensation. It’s sold as gels, gummies, oils, supplements and extracts.
What is cannabis (marijuana) research telling us about the potential benefits and risks of using cannabis for people with asthma and allergies?
Joanna Zeiger: Asthma is a disease with many causes, meaning not all patients with asthma react the same way to various triggers. For some people with asthma, cannabis is an immediate bronchodilator – it relaxes the airways which can help breathing. The drawbacks are that inhaled cannabis is an irritant and can cause increased cough, sputum and wheezing. So, risks far outweigh benefits and asthma specialists do not recommend inhaled or vaped cannabis for the treatment of asthma. Cannabis can be used to decrease anxiety, but it can also be a drawback if it decreases the appropriate concern for managing asthma – especially if that concern causes patients to stop taking prescribed medicines that control their asthma. The take-home message is cannabis should not be inhaled or vaped by people with asthma. Other preparations (e.g., oils, topicals, edibles) may not have any specific beneficial effects on asthma or other allergic diseases.
Are you suggesting asthma patients smoke cannabis (marijuana)?
Joanna Zeiger: We DO NOT recommend that people with asthma should smoke or vape cannabis. It is not a safe way to consume cannabis with this condition.
What do people need to know about starting cannabis (marijuana) as a medical treatment for asthma or allergies?
Joanna Zeiger: I always tell people the first thing to do is figure out what it is you want to treat. For those with chronic illnesses, it would be optimal to have a discussion with a physician knowledgeable in cannabis. Seek medical advice when starting any type of treatment. What are the symptoms you want to address? Is it nausea? Insomnia? Pain? The type of condition you are treating will help dictate which type of cannabis you need and how you consume it. Once you start using cannabis, keep a log of any change in your symptoms to determine whether cannabis is providing effective relief or possibly adverse effects. If a specific cannabis product doesn’t work, it may not be a failure of cannabis – it may not be the right product for you and your condition. Again, consulting with a physician knowledgeable about cannabis is important.
Can you explain what you mean when you say it may not be the right cannabis (marijuana) product?
Joanna Zeiger: There are all sorts of cannabis products out there. Some have lots of CBD and no THC, some have all THC and no CBD, and there are variations in between. Each person responds differently to different ratios of CBD and THC. It takes some time to determine what works best. Plus, there is the route of administration. Some people like oils, while others do better with edibles. We do not recommend inhalation for people with asthma. So there is some experimentation involved.
What are the different ways people can consume cannabis (marijuana) as a medical treatment?
Joanna Zeiger: The most common: smoking, vaping, tinctures, oils, topicals and edibles. How you take cannabis can have a different impact. The amount of time until you feel effects of the cannabis can also differ depending on how you administer cannabis. Smoking and vaping are not recommended for lung health due to reported adverse effects. Inhaling does lead to very fast onset of action, which may be beneficial for people who have severe acute pain but should be avoided in those with asthma. Edibles take much longer to work – up to 45-70 minutes – but the lasting effects are much longer than inhalation and can last for hours. This is ideal to aid sleep. Topicals work differently altogether and their effectiveness depends on the type of injury or pain you are trying to treat. That’s why defining your goal for cannabis use will help dictate your treatment options.
How safe is using cannabis (marijuana) as a medical treatment?
Joanna Zeiger: Inhaling cannabis is least safe for people with asthma. As noted previously, inhaling cannabis by smoking or vaping should be avoided by those with asthma. For anyone using cannabis, particularly those with a chronic illness, safety is paramount and comes first. Determine with your doctor the safest method of using cannabis and the lowest possible dose that provides optimal relief. Use cannabis responsibly. If you feel too high, sleep it off or wait it out. Do not overindulge. Even though cannabis can have medical value, it can also have adverse effects.
Should patients tell their doctor if they use cannabis oil or consume/smoke marijuana?
Joanna Zeiger: Yes, patients should not be afraid to discuss cannabis with their doctors. Patients want to be sure there won’t be any adverse effects of using cannabis with any other medications. And doctors need to know the benefits and adverse effects.
Do people have allergic reactions to cannabis (marijuana)?
Joanna Zeiger: Yes, people can have allergic reactions to cannabis. We do not yet know the exact numbers, but it can be an occupational hazard for those who work directly with the plant.
What are some benefits of cannabis (marijuana)?
Joanna Zeiger: We published several articles from a survey we did on athletes – the Athlete PEACE Survey study. The athletes reported several benefits to cannabis use. The athletes reported decreased pain, improved sleep, less anxiety, fewer muscle spasms and improved well-being. These benefits have also been reported in many other studies in medical patients. We know that cannabis is helpful for people with seizure disorders and can alleviate nausea and lack of appetite in cancer patients. There is evidence cannabis can help inflammatory bowel disease and rheumatic conditions. Additionally, cannabis seems to help people with post-traumatic stress disease (PTSD) and other mental health conditions.
What are some adverse effects of cannabis (marijuana)?
Joanna Zeiger: Cannabis can cause psychosis in some people, as well as cannabis hyperemesis syndrome, a situation where vaping of certain illicit products of cannabis causes severe abdominal pain and vomiting. Other adverse effects of cannabis include cough, wheeze, shortness of breath, sleepiness, poor concentration and coordination. The mantra in the world of cannabis is to “start low and go slow.” This means start with low doses and build up use slowly until you reach a beneficial amount or potential adverse effects. This approach is similar to starting most medications.
For eczema, is there a difference in using CBD vs. products that contain THC? Do they work on different immune issues? What sort of products do you recommend?
Joanna Zeiger: There just isn’t a lot known right now about how cannabis affects eczema. That is why we are doing the Allergy & Asthma Network PEACE survey – to learn more! It would be beneficial to speak to a doctor who specializes in cannabis to help direct you to products that could potentially help you without causing adverse effects.
Do you have asthma? And do you consume cannabis (marijuana)?
Joanna Zeiger: Yes, I have asthma and allergies. I also have chronic pain for which I use cannabis (edibles mainly, sometimes topicals). It has been helpful for sleep. It reduces pain and muscle spasms and decreases nausea.
What is the goal of the Allergy & Asthma Network PEACE Study?
Joanna Zeiger: We want to understand how people with asthma and allergies consume cannabis, whether it helps or hinders their allergic conditions and if cannabis affects their usual medication use to treat asthma and allergies. We also aim to understand knowledge and attitudes of cannabis in people with asthma and allergies. Different patient populations likely use cannabis differently, but to know for sure we must look at it systematically with the Allergy & Asthma Network PEACE Survey. Also, we need to start learning more about cannabis use and its impact on asthma, allergies, eczema and urticaria so we can educate patients and doctors on proper cannabis use.