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Researchers seek to better understand the link between asthma and cannabis

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Significant improvement in asthma patients after using cannabis

According to a recent study by the Israel Medical Association, asthma patients treated with cannabis have reduced their dependence on inhalers (ventoline type) and have significantly improved lung function, up to 8 times that of the drugs produced. The health ministry still refuses to allow asthmatic patients to receive this treatment.

Asthma does not appear in the list of eligible diseases for medical cannabis, although in the past in 1996, some lucky asthma patients received a license from the Ministry of Health.

As with other autoimmune diseases, many asthma patients claim that smoking cannabis helps them considerably and relieves seizures, but probably because there are not enough studies and perhaps because it is an anti tobacco action, governments are hesitant to add this disease to the list.

Asthma sufferers can now hope this is possible, after specialists at the Institute of Pulmonary Medicine at the Sha'arei Zedek Medical Center in Jerusalem have seen the results of three patients with severe asthma whose condition improved significantly after cannabis treatment.

Doctors have decided to examine the matter in depth and in a new scientific article published this month (April 2020) in the monthly journal of the Medical Association, they review existing research on cannabis and asthma and describe the improvement of their three patients.

Nothing helped asthma until the usefulness of cannabis was revealed

In the monthly journal of the Medical Association, the article begins with a description of the cases of 3 severe asthmatic patients who experienced a significant improvement in the disease following the treatment of medical cannabis. All patients have already been treated with a long-term inhaler used daily to prevent seizures, as well as an emergency inhaler used to stop an attack that has already started.

Case: Patient # 1

The first patient, a 30-year-old man who suffered from severe asthma since childhood, was treated with high doses of inhaled corticosteroids, beta receptor agonists and montelukast. Despite being treated for many of his recurrent asthma attacks, he continued and during a major attack he had to be connected to an artificial respirator.

When the patient first tried cannabis for pleasure, he noticed a significant improvement in his respiratory symptoms. He asked the Institute of Lung Medicine at the Shaare Zedek Medical Center in Jerusalem for medical cannabis for his asthma.

A routine FEV1 (Tiffeneau coefficient) lung capacity test that checks the amount of air exhaled in the first second of intense exhalation has confirmed that the patient is suffering from severe pulmonary obstruction. Inhalation of salbutamol, an asthma medication believed to open the airways and increase lung capacity, resulted in a minimum improvement of 2% in lung capacity, as measured by the FEV1 test.

The next step, the researchers let the patient consume low doses by spraying 0,1 g of cannabis, then repeat the FEV1 test again. This time, a 16% increase in lung capacity was measured, an improvement 8 times greater than that induced by salbutamol. He started receiving cannabis spray treatment and for the next three years had no asthma attacks and did not need an emergency inhaler.

Case: Patient # 2

A 36-year-old woman diagnosed with asthma, who had about XNUMX recurrent attacks, was treated daily with inhaled fluticasone and seretide and during a spontaneous attack, with corticosteroids for systemic use in addition to an emergency bronchodilator .

The severity of his illness necessitated an increase in the daily dose of medication, except that at the medium dosage, the medication caused him a serious side effect of candidiasis (fungal infection, sores in the oral cavity).

For about two years, the patient was treated with medical cannabis, used by spraying 3-4 times a week. Since the start of treatment, she indicated that she had no more seizures and that she did not feel the need to use an emergency inhaler. However, she is still using the asthma preventative medication because she suffered from interruptions (apnea) or reductions (hypopneas) in breathing during sleep.

Case: Patient # 3

A 34-year-old asthmatic man had to use an emergency inhaler at least 3 times a week despite the regular use of corticosteroids and beta-agonists to prevent seizures.

Following a serious car accident causing him multiple fractures, chronic pain, he received medical cannabis for his pain. When he started cannabis pain therapy, he also saw a marked improvement in his respiratory symptoms. Since then, he no longer needs an inhaler.

Cannabis and asthma: what does science say?

The above three cases, all of which showed significant improvement in asthma after cannabis treatment, greatly impressed the physicians at Jerusalem Institute of Pulmonary Medicine and decided to delve into scientific publication research to see if there were any studies on the relationship between cannabis and asthma. Here's what they found:

As with most parts of the body, cannabinoid receptors also exist in the health system. The CB1 receptors are dispersed in the nerves of the smooth muscle of the lung, and their role is likely to regulate the muscle tone of the lungs. CB2 receptors are found in immune cells, macrophages and lymphocytes, and are responsible for regulating inflammation.

When cannabis is consumed, it activates these receptors and causes two main effects:

Airway expansion (bronchodilation): from the 1970s and 1980s, first studies have shown that inhaled THC temporarily widens the airways and significantly (but only in the short term) the lung capacity of asthma patients. This was also achieved consistently across most studies carried out since then, with an increase from 150 to 250 ml of the results of the FEV1 test.

This effect of airway expansion (bronchodilation) begins about 5 minutes after you use inhaled cannabis and lasts until about two hours later. It has been found that consuming edible cannabis has a similar but less effective effect, its effect begins only about an hour after eating and lasts longer than smoking.

The bronchodilation effect of cannabis is, at least presumably, caused by the attachment of THC to CB1 receptors in the smooth muscle of the lung and its activation, causes muscle relaxation and leads to an expansion of the respiratory tract.

Reduction of inflammation Asthma is an autoimmune disease caused by an immune response, which attempts to attack an intruder and creates an inflammatory response that makes breathing difficult. Studies have shown that cannabinoids have an anti-inflammatory effect that limits the overreaction of the immune system in other autoimmune diseases such as multiple sclerosis and the Crohn's disease.

Specifically, asthma does not yet have long-term clinical studies in humans, but studies in mice have shown that the cannabinoids THC and CBN are effective in reducing the symptoms of allergic asthma, in which the immune system has a pathogenic reaction to air allergens. They do this by regulating Th2 cytokines and reducing the allergic response to the production of phlegm (mucus) due to the presence of allergens.

However, when cannabis is consumed by combustion, smoking itself causes exactly opposite effects to all these beneficial effects, narrowing of the respiratory tract and increase of allergic diseases. Cannabis smoke, like tobacco smoke contains combustion products which, in the long term, may worsen diseases like asthma.

The study notes that vaporization cannabis involves much less dangerous induction products, so in theory it should be less harmful, but for the moment no studies have examined this in depth, so it is not possible to determine with certainty whether vaporization long term cannabis affects health or not.

In addition to the direct effects on the lungs, the study also notes the indirect effects that cannabis can have on asthma. For example, studies on anti-anxiety effect components of cannabis (such as CBD) are mentioned because anxiety is a known trigger for asthma attacks. On the other hand, high doses of cannabis, especially those high in THC and low in CBD, can also cause anxiety, so this benefit can be reversed.

Another indirect benefit mentioned is the benefit of CBD against tobacco, a particularly harmful addiction for asthma patients. The effectiveness of CBD as that helps with smoking cessation has been shown in several studies, one of which even showed a 40% reduction in cigarette smoking by smokers when consumed in conjunction with the vaporization of CBD. However, it is still unclear whether this smoking-reducing effect continues over time.

In summary, doctors write that although there is convincing evidence of the positive effects of cannabis on short-term lung function, consumption by combustion has harmful long-term effects. Spraying is probably less dangerous and more research is needed to determine its safety.

When willinhaler cannabinoids for the relief or treatment of asthma patients? Over time, we hope to better understand the mechanisms of the effect of cannabinoids and perhaps even develop new drugs.

A study written by the magazine: Cannabis

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