{"doi":"10.1002/ppul.27187","title":"Childhood exposure to cannabidiol and lung function: A pilot study","abstract":"Cannabidiol (CBD) use has increased substantially in recent years, particularly since the legalization of hemp-derived CBD through the United States 2018 Agriculture Improvement Act. In the same year, the World Health Organization indicated that CBD is generally well-tolerated with a good safety profile. Consequently, by 2020, one in three American adults reported using a CBD product. CBD exposure among children may also be increasing, but no published studies have quantified the prevalence of this exposure. A 2022 poll reported that 7% of parents had given or considered giving their child a CBD product. However, this may underestimate children's actual exposure to CBD. Concurrent with this trend, pediatric respiratory health is a global health priority. Asthma alone affects one in 12 children and is the leading cause of medical-related school absenteeism. Respiratory health is thought to be driven by genetic and environmental factors, such as CBD exposure. Research surrounding the impact of CBD on respiratory function is limited to mouse models, which show that intraperitoneal injection or intranasal instillation of CBD reduces pulmonary inflammation,1-4 whereas CBD administered by vape induces pulmonary inflammation.5 To address these gaps in the literature, we conducted a pilot study by leveraging data from Healthy Start, an ethnically and racially diverse pre-birth cohort based in Colorado. Our aims were to objectively quantify childhood exposure to CBD at age 5 years and examine the relationship between biomarker-confirmed exposure and lung function at age 5 and 10 years. Between 2010 and 2014, Healthy Start recruited pregnant patients from the University of Colorado Hospital outpatient obstetrics clinics. Exclusions were multiple births and chronic disease. Visits occurred in pregnancy and childhood. Written consent was obtained before participation. The Colorado Multiple Institution Review Board approved the study protocol. Healthy Start began in 2010 as a study to better understand how overnutrition in pregnancy impacts obesity and cardiometabolic health of the offspring (NCT02273297). Beginning in October 2018, Healthy Start began to collect measures on lung function among eligible children as a pilot study. We measured CBD and delta 9-tetrahydrocannabinol (Δ9-THC, the most abundant cannabinoid) in urine collected at 5 years. Samples were analyzed by iC42 Clinical Research and Development (Aurora, CO) using a validated, specific, and highly sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. The LC-MS/MS system consisted of a 1200 high-performance liquid chromatography system (Agilent Technologies) and an API5000 tandem mass spectrometer (Sciex) connected via an atmospheric pressure chemical ionization source run in the positive mode. CBD exposure was dichotomized as exposed (>limit of quantification [LOQ]; generally, 0.78 ng/mL) or not exposed (