Histopathologic and clinical abnormalities of the respiratory system in chronic hashish smokers

Thirty chronic hashish smokers (mean age-20 years) with respiratory symptoms and six control subjects who were nonhashish smokers were evaluated by history, physical examination, bronchoscopy, and bronchial biopsy. Twenty-three (23) of 23 (100 percent) patients who smoked hashish plus cigarettes had one or more histopathologic abnormalities of basal cell hyperplasia, atypical cells, or squamous cell metaplasia. Only one of seven (28.6 percent) hashish smokers who smoked cigarettes, one of three (33.3 percent) cigarette smokers who smoked no hashish, and zero of three (0 percent) nonsmokers showed one or more of the same histopathologic lesions (p less than .05). Hashish smoking when combined with cigarette smoking appeared to have more deleterious pulmonary effects than either hashish or cigarettes smoked alone, and the abnormal histopathologic lesions found in these smokers are identical to those frequently associated with later development of emphysema and carcinoma of the lung.