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)
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health and wellness
Heart Risks Go Beyond the Heart: Don’t Forget to Check Blood Sugar and Kidney Health
Heart Risks Go Beyond the Heart: Don’t Forget to Check Blood Sugar and Kidney Health
(Feature Impact) Diabetes and kidney disease are major risk factors for heart disease, yet many cases are undiagnosed. In fact, most people don’t realize their heart, kidney and metabolic health – how the body creates, uses and stores energy – are connected. Understanding these connections can help you take steps toward protecting your long-term health.
Cardiovascular-kidney-metabolic (CKM) syndrome is a health condition that includes heart disease, kidney disease, diabetes and obesity. Many people don’t realize they’re at risk, though, because they aren’t aware of health risks beyond the heart. Almost 1 in 4 U.S. adults with diabetes are unaware they have it, according to a 2026 statistics update from the American Heart Association. In addition, data from the Centers for Disease Control and Prevention shows that as many as 9 in 10 adults with chronic kidney disease don’t know they’re living with the condition.
Learning about CKM syndrome can be a helpful step in understanding your overall health picture.
How are CKM conditions connected?
Heart disease, kidney disease and diabetes have shared risk factors – including high blood pressure, cholesterol and blood sugar; excess weight; and reduced kidney function – and they’re closely linked. Having one condition often increases the likelihood of developing the others.
“We are encouraging people to become aware of the connection between conditions so they and their health care team can think about their overall health beyond individual conditions,” said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association, executive director of the Katz Institute for Women’s Health and senior vice president of women’s health at Northwell Health. “Understanding the connection helps you better prevent complications through lifestyle changes and appropriate treatment.”
The biggest health threats from CKM syndrome are disability and death from heart disease and stroke, which make up the “cardiovascular” part of CKM. The “metabolic” part includes diabetes and obesity. Kidney disease is closely linked with both metabolic and cardiovascular diseases.
How common is CKM syndrome?
CKM-related risks are common. Nearly 90% of U.S. adults have at least one risk factor for CKM syndrome. The 2026 statistics report showed about half of all U.S. adults have high blood pressure, about 1 in 3 has high total cholesterol, more than half have prediabetes or diabetes, about 1 in 7 has kidney disease and more than half have a high waist circumference.
These risks often develop slowly, with few or no symptoms at first, but you can stay informed. Rosen emphasizes regular screening of your cardiovascular, kidney and metabolic health, which can catch problems early.
“Due to the current risk factor rates, everyone could benefit from being screened this way,” she said.
Regular check-ins with your health care team can offer a clearer picture of your CKM health. They can check your:
- Blood pressure
- Cholesterol panel (total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides)
- Blood glucose (blood sugar), measured in either the short term as fasting glucose or long term as A1C
- Body weight and size, measured by body mass index and waist circumference
- Kidney function, using both UACR and eGFR
These results can be used in the PREVENT online calculator to estimate your risk for cardiovascular disease over the next 10 or 30 years. CKM syndrome can often be prevented and improved with healthy daily habits like those in Life’s Essential 8 and science-based treatments.
The CKM Health Initiative was introduced by the American Heart Association to raise awareness of the connections between CKM syndrome conditions and improve diagnosis rates. It’s supported by founding sponsors Novo Nordisk and Boehringer Ingelheim, supporting sponsors Novartis Pharmaceuticals Corporation and Bayer, and champion sponsor DaVita.
Visit Heart.org/myCKMhealth to learn more about CKM health, including screening and treatment options.
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Our Lifestyle section on STM Daily News is a hub of inspiration and practical information, offering a range of articles that touch on various aspects of daily life. From tips on family finances to guides for maintaining health and wellness, we strive to empower our readers with knowledge and resources to enhance their lifestyles. Whether you’re seeking outdoor activity ideas, fashion trends, or travel recommendations, our lifestyle section has got you covered. Visit us today at https://stmdailynews.com/category/lifestyle/ and embark on a journey of discovery and self-improvement.
Last Updated on April 6, 2026 by Daily News Staff
(Feature Impact) Heart disease is something many adults push to the back of their minds if they are not experiencing symptoms; a concern for “later” in life. However, that mindset may be changing. New research suggests younger generations are thinking about their cardiovascular health earlier and with greater urgency.
They’re right to be thinking about it, too. Data from the American Heart Association shows heart disease is still the No. 1 killer of Americans. In fact, someone dies from cardiovascular disease every 34 seconds in the United States.
Risk factors such as obesity, high blood pressure, diabetes, and kidney disease are on the rise, too. Nearly half of U.S. adults have high blood pressure (47%), and obesity (42%), and more than half (57%) have type 2 diabetes or prediabetes.
Despite growing concern about heart health, many adults remain unclear about their personal risk. In fact, a majority of respondents (62%) in a survey conducted by Atomik Research on behalf of Doctor’s Best said they don’t know their current risk for heart disease. To provide context on these findings and highlight emerging heart health trends, Dr. Tania Elliott, a dual board-certified physician in internal medicine, offers some insights.
Feeling Fatigue
In the study, only 50% of respondents reported feeling energetic on a daily basis. Among those who reported feeling fatigued, 46% listed stress as their top perceived contributor, followed by insufficient sleep (38%), both of which are closely tied to cardiovascular health.
Troubling Symptoms
Among Gen Z respondents, 25% reported having shortness of breath during activity or while lying down, compared to just 16% of Baby Boomers, which is commonly associated with compromised heart health.
Statins and Youth
Statins, which help address cardiovascular risk factors such as high cholesterol, are among the most commonly prescribed drugs in America, with more than 92 million Americans currently taking them, according to the Cleveland Clinic. Although most survey respondents (76%) aren’t currently taking a statin, 17% of adults ages 25-34 reported using statin therapy, which is an unexpectedly high proportion given their age and the group’s low anticipated risk of cardiovascular disease.
Side Effects of Statins
Among those taking statins, which are considered a first-line treatment for treating high cholesterol and reducing heart disease risk, 54% reported experiencing side effects, particularly muscle pain (23%) and fatigue (31%). However, taking statins can also affect levels of Coenzyme Q10 (CoQ10), which supports cellular energy and cardiovascular function.
All About CoQ10
Cells use CoQ10 to produce energy and detoxify. Studies have shown people with heart failure who took CoQ10 had around a 50% reduction in mortality. Despite this, awareness is low. Nearly two-thirds (66%) of respondents had never heard of CoQ10 and that number jumps to 76% of adults ages 25-34. Additionally, only a small percentage of respondents (8%) who were on a statin reported having their CoQ10 level tested.
“We have a real opportunity to help younger adults take a more proactive approach to heart health,” Elliott said. “CoQ10 plays a critical role in cellular energy production and heart muscle function, and it can decline with age and statin use.”
If you’re among the 71% of survey respondents who expressed a willingness to learn more about improving your heart health, talk with your health care provider and visit DoctorsBest.com to learn more.
Strategies to Support Heart Health
While some risk factors for heart disease, like age and family history, are out of your control, you can make lifestyle changes to help lower your risk:
- Eat Whole Foods: A heart-healthy eating plan includes plenty of lean proteins as well as fruits, vegetables, beans, whole grains and foods high in omega-3s, such as salmon, nuts and plant oils.
- Know Your CoQ10 Levels: If you’re low, look for a high-quality, bioavailable formula, like Doctor’s Best High Absorption CoQ10 with BioPerine, which supports energy production and muscle function.
- Get Moving: The American Heart Association recommends 150 minutes of moderate-intensity or 75 minutes of vigorous aerobic activity per week to help control weight and lower the risk for conditions that negatively impact the heart.
Photo courtesy of Shutterstock (woman with hand over chest)
SOURCE:
Our Lifestyle section on STM Daily News is a hub of inspiration and practical information, offering a range of articles that touch on various aspects of daily life. From tips on family finances to guides for maintaining health and wellness, we strive to empower our readers with knowledge and resources to enhance their lifestyles. Whether you’re seeking outdoor activity ideas, fashion trends, or travel recommendations, our lifestyle section has got you covered. Visit us today at https://stmdailynews.com/category/lifestyle/ and embark on a journey of discovery and self-improvement.
Community
Viewpoint Hosted by Dennis Quaid Brings Attention to a Little-Understood Condition Affecting Families Nationwide
A new Viewpoint hosted by Dennis Quaid segment with APFED raises awareness of eosinophilic esophagitis, its subtle symptoms, and its impact on families.
For more information, readers can visit viewpointproject.com and apfed.org.
For many families, health conditions do not always begin with a dramatic diagnosis. Sometimes they show up in small, everyday habits that seem easy to explain away. Cutting food into tiny bites. Drinking extra water with every meal. Quietly avoiding certain foods altogether. A new educational segment from Viewpoint hosted by Dennis Quaid is shining a light on those subtle warning signs through a collaboration with the American Partnership for Eosinophilic Disorders, helping more people recognize the realities of living with eosinophilic esophagitis, or EoE.
Viewpoint hosted by Dennis Quaid
The segment, distributed to Public Television stations across the country, focuses on making this chronic inflammatory condition easier for the public to understand. For viewers, that matters because EoE is often misunderstood or overlooked, even as it affects daily routines, family meals, and quality of life. By connecting medical information to real-life experiences, the program gives audiences a more human picture of what people with the condition may be facing.
When everyday habits tell a bigger story
Eosinophilic esophagitis occurs when eosinophils, a type of white blood cell, build up in the esophagus, causing inflammation that can lead to tissue damage and narrowing. But what stands out most in this story is not just the science. It is the way people often adapt without realizing it. Behaviors like chewing excessively, avoiding certain textures, or relying on liquids to help swallow can become so routine that they no longer feel unusual.
That is one reason the segment carries real community value. It encourages people to look more closely at symptoms that may have been normalized for years and to seek evaluation from specialists such as gastroenterologists or allergists. It also raises awareness among parents, caregivers, and primary care providers who may be the first to notice that something is not quite right.
More than awareness
The program also explores the emotional and social side of the condition, especially for people navigating dietary restrictions and the uncertainty of delayed diagnosis. In that sense, this is not only a story about medicine. It is also a story about advocacy, support, and the importance of helping people feel seen.
APFED Executive Director Mary Jo Strobel noted that many people with EoE do not realize they have adapted their lives around a medical condition. That message gives the segment its strongest human element: awareness can change lives, not only by leading to diagnosis, but by helping families better understand experiences that may have felt isolating or confusing.
Originally distributed in January 2025, the documentary will continue to be made available to stations through March 2027, extending its reach to more households nationwide.
Related Coverage
Read more from STM Daily News on community issues, public television, health awareness, and stories that connect national topics to everyday life.
For More Information
- Visit the official Viewpoint hosted by Dennis Quaid website
- Learn more about the American Partnership for Eosinophilic Disorders
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