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Bullous lung disease due to marijuana HII SW, TAM JDC, THOMPSON BR, NAUGHTON MT. Respirology 2008; 13: 122–127 Background and objective: In contrast to the well-described effects of tobacco smoking upon pulmonary emphysema, with ∼15% of smokers being affected at the age of 65 years, the effects of marijuana smoking are rarely reported and poorly understood. Methods: We report a series of 10 patients (mean age 41 ± 9 years, eight male, two female), who presented over a period of 12 months to our respiratory unit with new respiratory symptoms, and who admitted to regular chronic marijuana smoking (>1 year continuously). Symptoms on presentation were dyspnoea (n = 4), pneumothorax (n = 4) and chest infection (n = 2). Results: High-resolution CT revealed asymmetrical, variably sized, emphysematous bullae in the upper and mid zones. However, the CXR was normal in four patients and lung function was normal in five. Conclusions: Marijuana smoking leads to asymmetrical bullous disease, often in the setting of normal CXR and lung function. In subjects who smoke marijuana, these pathological changes occur at a younger age (approximately 20 years earlier) than in tobacco smokers.