health and wellness
Millions of Long-Term Smokers Have Lung Disease that Defies Diagnosis
UCSF study finds current definition of chronic tobacco-related lung diseases leaves patients undiagnosed and untreated
Last Updated on September 6, 2025 by Daily News Staff
Prescott Woodruff, MD, MPH, UCSF Division Chief of Pulmonary, Critical Care, Allergy and Sleep Medicine
« Millions of Long-Term Smokers Have Lung Disease that Defies Diagnosis
Newswise — Millions of Americans with tobacco-related lung disease have symptoms that do not fit any existing tobacco-related disease criteria – including the most common of those, chronic obstructive pulmonary disease (COPD) – according to a new study led by researchers at UC San Francisco.
In a study publishing Aug. 1, 2023, in the Journal of the American Medical Association (JAMA), the research team found that half of the participants with extensive tobacco exposure had a persistently high level of respiratory symptoms, including shortness of breath, daily cough and phlegm, and decreased ability to exercise, but performed well in the breathing tests used to diagnose COPD.
COPD assessment was an essential part of the “SubPopulations and InteRmediate Outcome Measures In COPD Study” (SPIROMICS) – a multicenter study of 1379 people 40 to 80 years old who had more than 20 pack-years of tobacco exposure (smoking one pack of cigarettes per day for 20 or more years). The study also included control participants who had never smoked cigarettes and did not have airflow obstruction.
COPD is the sixth leading cause of death in the United States and is frequently associated with long-term tobacco exposure. In 2020, an estimated 12.5 million Americans reported having been diagnosed with COPD, according to the Centers for Disease Control and Prevention. Yet previous studies indicated that more than 18 million had evidence of impaired lung function, a sign that millions more might be suffering without a clear diagnosis.
COPD is assessed with spirometry, a lung function test that measures how quickly and effectively a person can fill and then empty their lungs at maximum effort. It is diagnosed when the test shows airflow obstruction, indicating a problem with getting enough air out in the normal amount of time. Evidence of airflow obstruction is medically defined as an abnormally low ratio of the forced expiratory volume in the first second (FEV1) of an exhalation to total forced vital capacity (FVC).
“We found that many people who have a lot of primary tobacco exposure have the same symptoms as people who have COPD, but can’t be diagnosed with COPD, because their FEV1/FVC ratio is considered normal on spirometry,” said William McKleroy, MD, a former UCSF Pulmonology Fellow and first author of the study. “This demonstrates a major gap in effective and compassionate care for tobacco-exposed persons and highlights the need for further study to find ways to help them.”
Participants were enrolled in SPIROMICS I from November 2010 to July 2015 and followed through July 2021 in an extension study, SPIROMICS II. They underwent spirometry, 6-minute walk distance testing, assessment of respiratory symptoms, and CT scans of their lungs, at yearly visits for 3 to 4 years. Many of these participants then completed another round of testing 5 to 10 years after their original visit.
Some of the study participants were found to have COPD after undergoing spirometry, while others had “preserved spirometry,” meaning they did not have COPD. The researchers found that the vast majority of the participants with tobacco exposure and preserved spirometry (TEPS) and pulmonary symptoms at the beginning of the study continued to have symptoms through more than five years of follow-up. They also had high rates of respiratory exacerbations and shortness of breath that limited their ability to be active over the course of the study.
Additionally, participants with symptomatic TEPS did not have increased incidence of COPD compared those with asymptomatic TEPS (33.0% among participants with symptomatic TEPS vs. 31.6% among those with asymptomatic TEPS), or a faster rate of lung function decline, as measured by the decline in FEV1 over time, compared to asymptomatic TEPS participants. By contrast, participants with COPD did have a more rapid rate of FEV1 decline compared to symptomatic TEPS participants.
“These findings suggest that a large proportion of tobacco smoke-exposed persons without airflow obstruction have a persistent, symptomatic non-obstructive chronic airway disease that is distinct from COPD,” said Prescott Woodruff, MD, MPH, UCSF division chief of Pulmonology and principal investigator for SPIROMICS. “Although tobacco-exposed persons with preserved spirometry are currently categorized as having pre-COPD by the COPD guidelines, the data from the current study emphasize that the definition of smoking-related lung disease needs to be broadened so new treatments can be developed.”
The study found that many individuals with a history of smoking have respiratory symptoms and increased risk of exacerbations that persist over several years, added James Kiley, Ph.D., director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.
“Even in persons with no respiratory symptoms and normal breathing tests, smoking continues to harm their lungs,” Kiley said. “The study results highlight the importance of smoking cessation, underscore the need for regular follow-up of smokers with and without symptoms, and call for more research to treat respiratory symptoms due to smoking.”
In addition to the findings related to symptomatic TEPS, the study also found a higher proportion of black individuals in the study had symptomatic TEPS compared with white participants. They also found an increased risk of progression to COPD in black participants as compared with white participants in this study. The authors suggest an evaluation of the contribution of occupational and environmental exposures, socioeconomic status and structural racism to the development of these symptoms.
Authors: In addition to Woodruff, additional UCSF authors include Mehrdad Arjomandi, MD, and Stephen Lazarus, MD. For other authors, please see the study.
Funding: The study was supported by the National Heart, Lung, and Blood Institute (grants U01 HL137880, U24 H141762, F32HL158222, 5K24LH137013). See the study for additional funders.
About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a top-ranked specialty hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland; Langley Porter Psychiatric Hospital and Clinics; UCSF Benioff Children’s Physicians; and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit https://ucsfhealth.org. Follow UCSF Health on Facebook or on Twitter.
Source: University of California, San Francisco (UCSF)
health and wellness
Zepbound Linked to Lower Healthcare Costs in Adults 55+ With Obesity, Real-World Study Suggests
A new real-world study of adults over age 55 with overweight or obesity found that sustained use of Zepbound (tirzepatide) for weight management was associated with lower healthcare costs over time compared with similar adults who were not treated. Eli Lilly and Company said the findings were driven in part by lower rates of hospital admissions and emergency department visits, and were published in Diabetes, Obesity and Metabolism.
What the study found
According to Lilly, researchers estimated healthcare cost differences over time (excluding the cost of Zepbound itself) using two established analytic methods. Across both approaches, monthly healthcare costs were lower, on average, among older adults who stayed on Zepbound.
Key estimates reported in the release include:
- At six months: costs were up to 15% lower (up to $181 per patient, per month).
- At 12 months: the estimated difference widened to as much as $607 per patient, per month, reflecting up to 38% lower costs than those not treated (estimates varied by model).
In the primary analysis, adults over 55 treated with Zepbound had lower rates of hospital admissions and emergency department visits across every follow-up period, along with numerically higher rates of routine outpatient and office visitsa pattern the company said was consistent with greater engagement in routine care.
Why Medicare is part of the conversation
Lilly said the cost findings may be relevant for older adults, including those in Medicares GLP-1 Bridge program. The company noted that beginning at six months, estimated healthcare savings nearly covered the programs monthly treatment cost of $195 per patient, per month, and by 12 months the estimated savings exceeded the reported monthly treatment cost.
Its important to note the release also emphasizes a limitation: claims data do not capture Zepbounds net price, and the study excluded the cost of Zepbound from total treatment costs. That means the reported differences reflect potential savings elsewhere in care that could offset treatment costs, not the full net cost impact.
Who was included in the analysis
The retrospective observational cohort study used Komodos Healthcare Map, a database of de-identified claims data from more than 330 million individuals enrolled in U.S. healthcare plans. The analysis included 15,843 adults over age 55 (mean age 64.5) with obesity or overweight plus at least one obesity-related complication who initiated Zepbound between November 2023 and September 2025. Each Zepbound user was matched 1:1 with a control participant who met the same eligibility criteria but did not initiate GLP-1 or GIP/GLP-1 receptor agonist medication.
What Zepbound is
Zepbound (tirzepatide) is a dual GIP and GLP-1 receptor agonist indicated for adults with obesity, or some adults with overweight who also have at least one weight-related medical problem, to lose weight and keep it off. Lilly also noted Zepbound is FDA-approved to treat adults with moderate-to-severe obstructive sleep apnea and obesity, and should be used alongside a reduced-calorie diet and increased physical activity.
Safety summary (high level)
The release includes an indications and safety summary with warnings. Among other risks, Lilly notes Zepbound carries a warning about thyroid tumors, including thyroid cancer, and may cause serious side effects such as severe stomach problems, dehydration leading to kidney problems, gallbladder problems, pancreatitis, serious allergic reactions, and low blood sugar (especially when used with certain diabetes medicines). Patients should talk with a healthcare provider about risks and whether the medication is appropriate for them.
Related Links
- Zepbound (official product site): https://zepbound.lilly.com/
- Lilly newsroom: https://www.lilly.com/news
- Journal page (publisher hub): https://dom-pubs.onlinelibrary.wiley.com/journal/14631326
- Medicare (official): https://www.medicare.gov/
- FDA MedWatch (side effect reporting): https://www.fda.gov/medwatch
Source
- PRNewswire / Eli Lilly and Company press release (Aug. 26, 2026): Zepbound linked to lower healthcare costs in adults over age 55 with obesity according to a real-world study
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(Feature Impact) When it comes to stroke, time matters. Recognizing the warning signs and calling 911 quickly can help with receiving time-sensitive, life-saving treatment. Recovery should begin early, too.
Having a stroke can divide life into a stark before and after, affecting many aspects of daily life. While it’s easy to focus on the things a stroke can take away, it’s important to remember there’s life after stroke. Recovery isn’t just about relearning skills. It’s about adapting to new challenges, finding purpose in a different reality and continuing to move forward.
Navigating the aftermath of a stroke means balancing short-term and long-term plans. Once medically stable, rehabilitation should ideally begin within 48 hours, according to the 2026 Guideline for Adult Stroke Rehabilitation and Recovery from the American Stroke Association. Recovery doesn’t have a fixed end. Meaningful progress can continue for months or years after survivors leave the hospital or complete formal therapy.
“Stroke rehabilitation is complicated,” said Lorie Gage Richards, Ph.D., FAHA, volunteer chair of the new guideline, associate professor at the University of Utah and an occupational therapist. “Each person faces a different set of challenges and care should be personalized to fit each person’s needs. The goal is to help individuals gain as much independence as possible to perform everyday activities while improving their overall quality of life.”
Approximately 800,000 people have a stroke each year in the U.S, according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics. Whether you’re navigating recovery yourself or supporting someone you love, connecting with a coordinated healthcare team is an important first step. Ask about a comprehensive assessment, develop a rehabilitation plan based on what matters to you and set small, achievable goals throughout recovery.
Building Skills and Independence
After a stroke, familiar parts of a daily routine may take more effort or require a new approach. A rehabilitation team can assess how stroke has affected movement, communication, thinking, vision, hearing and other abilities then develop a plan based on individual needs and goals.
Recovery doesn’t look the same for everyone. For one person, a meaningful goal may be dressing independently. For others, it could be returning to work, driving safely or participating in favorite activities. Start with manageable goals, evaluate progress and reassess the plan as needs change.
Understanding the Invisible Impacts
Some of the most challenging parts of recovery may be the ones others can’t see. For instance, you might lose confidence or sense of identity, have trouble concentrating or experience anxiety or depression. Along with mental and emotional changes, you may notice ongoing physical symptoms like pain, difficulty sleeping, changes in sexual function or difficulty with bladder control.
Invisible challenges don’t have to stay that way. Ask your healthcare team to assess your physical and emotional health, including depression and anxiety, during the hospital stay and throughout recovery. Speaking up about new or changing symptoms can help identify appropriate treatment and support.
Navigating Changing Relationships
When you have a stroke, your life isn’t the only one that changes. A partner, parent or friend may suddenly take on new responsibilities, making honest conversations about support especially important.
Family responsibilities may also look different. Parenting young children, supporting loved ones or balancing work and family can bring new challenges during recovery. Give yourself permission to slow down, accept care and connect with the people who matter most.
Finding Purpose and Redefining Success
Recreation, hobbies, social connections and other meaningful activities are an important part of recovery and can help people regain confidence, participate in their communities and improve quality of life. That may mean returning to music, art, exercise or time with friends. It could also mean modifying favorite activities, discovering new interests or connecting with a support group.
Life after stroke may look different, but different doesn’t mean less meaningful. Recovery isn’t measured by how closely someone returns to who they were before. It’s about finding new ways to pursue what matters most and continuing to move forward.
Learn more about recognizing stroke, preparing for rehabilitation and adjusting to life after stroke by visiting Stroke.org.
Photos courtesy of Shutterstock
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Health
5 Babyproofing Tips for Baby Safety Month
Babyproofing is about anticipating those discoveries before little ones make them. In honor of National Baby Safety Month, consider these tips you can use to make your home safer all year round.
5 Babyproofing Tips for Baby Safety Month
(Feature Impact) Outsmarting a baby can be harder than it sounds – especially when it comes to transforming your home into a safe place for them to explore. Through their eyes, a coffee table becomes a climbing opportunity, a dangling phone charger looks like a teething toy and a cabinet of cleaning supplies could be an exciting travel destination.
Babyproofing is about anticipating those discoveries before little ones make them. In honor of National Baby Safety Month, consider these tips to make your home safer all year round.
Install Gates and Doorknob Covers
Crawling babies and stairs are a bad combination. Make sure the two never have the chance to meet by securely installing safety gates at the top and bottom of staircases to thwart young explorers. Gates or doorknob covers can also block access to other rooms and areas you’d prefer to keep off limits, like kitchens, bathrooms and laundry areas.
Use Safety Latches Wisely
Cabinets and drawers can contain a myriad of dangerous items, from cleaning products to sharp objects and medications. Even if you have rooms gated off, treat safety latches and locked storage receptacles as a second line of defense to make sure babies and toddlers can’t rummage where they shouldn’t.
Stress-Test Furniture
As babies and toddlers transition from crawling to walking, they often try using furniture to pull themselves up. Tall or unstable objects like TV stands, small tables and bookshelves can tip over if they aren’t properly secured. Try giving these objects a shake to see whether they’re easily moveable or wobbly; if so, anchor them to the floor or wall when possible. While you’re at it, check for sharp corners at the right height to bonk little heads and cover them with softer edge protectors.
Cover Outlets and Stow Cords
Electrical outlets can be tempting targets for curious fingers. Outfit them with covers or plastic safety caps, especially if you don’t already have tamper-resistant receptacles with built-in mechanisms to block foreign objects from entering the slots. As you’re going about your outlet audit, pay attention to cords as well. When possible, tuck them away or secure them with cord organizing systems, and block access to objects like lamps where cords can be used for tugging and toppling.
See the World at Their Level
Although it might feel silly, one of the best ways to spot hazards around your home is to scout for them from a baby’s perspective. Try getting as close to the floor as you can then look around each room for anything that could interest a young child and pose potential danger. In particular, keep an eye out for small objects that could become choking hazards, like dropped coins, batteries or loose toy pieces.
As children grow, so do the needs of your space. Visit eLivingtoday.com for more ideas on designing your home to fit your family.
Photo courtesy of Unsplash
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