B16-08 Impact of Marijuana Use on Asthma Exacerbation Outcomes: Insights From a Multi-Institutional Real World Dataset

Abstract Rationale Marijuana is among the most commonly used psychoactive substances worldwide, with its prevalence increasing following the legalization of recreational use. Previous studies have yielded conflicting evidence regarding the effects of marijuana on clinical outcomes, potentially leading to misinterpretation among patients and healthcare providers. This study aimed to evaluate the association between marijuana use and clinical outcomes among patients hospitalized for acute asthma exacerbations. Methods We conducted a retrospective cohort study using the TriNetX Research Network, a global database of de-identified electronic health records from multiple healthcare organizations. Adult patients (≥18 years) hospitalized with a diagnosis of asthma exacerbation or status asthmaticus were identified using ICD-10 codes. Patients were categorized into two cohorts based on documented marijuana use. The primary outcome was in-hospital mortality. Secondary outcomes included the need for noninvasive ventilation, invasive mechanical ventilation, extracorporeal membrane oxygenation (ECMO), and laboratory measures such as inflammatory markers and absolute eosinophil counts. Propensity score matching (1:1) was performed to balance baseline characteristics, including age, sex, race, smoking status, obesity, and comorbidities. Statistical analyses were conducted within the TriNetX platform, and risk ratios (RR) with 95% confidence intervals (CI) were reported. Results A total of 140,686 patients were included after propensity score matching, with 70,343 patients in each cohort. Marijuana use was associated with a higher risk of all-cause 30-day mortality (RR 1.68, 95% CI 1.40-2.02, p 0.001) and increased requirements for noninvasive ventilation (RR 1.23, 95% CI 1.08-1.40, p = 0.001), invasive mechanical ventilation (RR 1.65, 95% CI 1.39-1.94, p 0.001), and extracorporeal membrane oxygenation (ECMO) (RR 2.21, 95% CI 1.18-4.16, p = 0.011). Marijuana users were also more likely to have eosinophils comprising 10% of the total white blood cell count (RR 1.36, 95% CI 1.20-1.54, p 0.001). No significant differences were observed in total white blood cell count, absolute eosinophil count, erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP) levels between the two groups. Conclusions Among patients hospitalized for acute asthma exacerbation, marijuana use was associated with increased morbidity and mortality, despite no significant differences in systemic inflammatory markers. Clinicians should consider marijuana use as a potential risk factor when managing asthma exacerbations. Further research is needed to elucidate the underlying mechanisms and to guide targeted interventions to prevent and mitigate its adverse effects in this population. This abstract is funded by: None