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A previous paper from this hospital described apical lung bullae in four young male marijuana smokers, three West Indian and one Caucasian.1 Two further cases were recently reported, both in Caucasian men.2 We describe three further cases (one woman) with large upper lobe bullae. All are Caucasian and had a prolonged history of heavy marijuana smoking with an alpha1-antitrypsin level within the normal range (table). These further cases support the view that marijuana may have a causal role in the development of lung bullae. We suggest that a detailed marijuana smoking history is taken from patients of all ethnic origins with upper lobe bullae.
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