Health
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
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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Food and Beverage
Cinnamon, spice and ‘everything nice’ – why lead-tainted cinnamon products have turned up on shelves, and what questions consumers should ask
A Consumer Reports investigation revealed alarming lead levels in ground cinnamon, prompting concerns over safety, especially for children and pregnant women.
Katarzyna Kordas, University at Buffalo
Spices bring up feelings of comfort, cultural belonging and holidays. They can make our homes smell amazing and our food taste delicious. They can satisfy our cravings, expand our culinary horizons and help us eat things that we might normally dislike. Spices have health-enhancing properties and, in medicine, have been used to heal people since the ancient times.
Recently, however, spices have been getting a bad rep.
In September 2024, Consumer Reports, a nonprofit organization created to inform consumers about products sold in the U.S., investigated more than three dozen ground cinnamon products and found that 1 in 3 contained lead levels above 1 part per million, enough to trigger a recall in New York, one U.S. state that has published guidelines for heavy metals in spices.
The Food and Drug Administration issued three alerts throughout 2024, warning consumers about lead in certain brands of cinnamon products. Such notices rightfully put consumers on alert and have people wondering if the spice products they buy are safe – or not. https://www.youtube.com/embed/QxAwznMht8M?wmode=transparent&start=0 A Consumer Reports investigation of more than three dozen ground cinnamon products found that 1 in 3 contain lead levels above 1 part per million.
As an environmental epidemiologist with training in nutritional sciences, I have investigated the relationship between nutritional status, diets and heavy metal exposures in children.
There are several things consumers should be thinking about when it comes to lead – and other heavy metals – in cinnamon.
Why is lead found in cinnamon?
Most people are familiar with cinnamon in two forms – sticks and ground spice. Both come from the dried inner bark of the cinnamon tree, which is harvested after a few years of cultivation. For the U.S. market, cinnamon is largely imported from Indonesia, Vietnam, Sri Lanka, India and China.
One way that lead could accumulate in cinnamon tree bark is when trees are cultivated in contaminated soil. Lead can also be introduced in cinnamon products during processing, such as grinding.
When ground cinnamon is prepared, some producers may add lead compounds intentionally to enhance the weight or color of the product and, thus, fetch a higher sale price. This is known as “food adulteration,” and products with known or suspected adulteration are refused entry into the U.S.
However, in the fall of 2023, approximately 600 cases of elevated blood lead levels in the U.S., defined as levels equal to or above 3.5 micrograms per deciliter – mostly among children – were linked to the consumption of certain brands of cinnamon apple sauce. The levels of lead in cinnamon used to manufacture those products ranged from 2,270 to 5,110 parts per million, indicating food adulteration. The manufacturing plant was investigated by the FDA.
More broadly, spices purchased from vendors in the U.S. have lower lead levels than those sold abroad.
There is some evidence that cinnamon sticks have lower lead levels than ground spice. Lead levels in ground cinnamon sold in the U.S. and analyzed by Consumer Reports ranged from 0.02 to 3.52 parts per million. These levels were at least 1,500 times lower than in the adulterated cinnamon.
There are no federal guidelines for lead or other heavy metals in spices. New York state has proposed even stricter guidelines than its current level of 1 part per million, which would allow the New York Department of Agriculture and Markets to remove products from commerce if lead levels exceed 0.21 parts per million.
What does it mean that ‘the dose makes the poison’?
The current FDA guideline on daily intake of lead from diets overall is to limit lead intake to 2.2 micrograms per day for children. For women of reproductive age, this value is 8.8 micrograms.
The lead dose we are exposed to from foods depends on the level of lead in the food and how much of that food we eat. Higher doses mean more potential harm. The frequency with which we consume foods – meaning daily versus occasionally – also matters.
For spices like cinnamon, the amount and frequency of consumption depends on cultural traditions and personal preference. For many, cinnamon is a seasonal spice; others use it year-round in savory dishes or sauces.
Cinnamon is beloved in baked goods. Take a cinnamon roll recipe calling for 1.5 tablespoons (slightly less than 12 grams) of the spice. If a recipe yields 12 rolls, each will have around 1 gram of cinnamon. In the Consumer Reports investigation, some cinnamon products were classified as “okay to use” or “best to use.”
The highest value of lead in cinnamon products in the “okay to use” category was 0.87 parts per million, and in the “best to use” category, it was 0.15 parts per million. A child would have to consume 2.5 or more rolls made with the “okay to use” cinnamon to exceed the FDA guideline on limiting lead intake from foods to 2.2 micrograms per day, assuming that no other food contained lead. To exceed this guideline with “best to use” cinnamon, a child would have to eat 15 or more rolls.
Can cinnamon contribute to elevated blood lead levels?
Because of lead’s effects on development in early life, the greatest concern is for exposure in young children and pregnant women. Lead is absorbed in the small intestine, where it can latch onto cellular receptors that evolved to carry iron and other metals.
The impact of a contaminated spice on a person’s blood lead level depends on the dose of exposure and the proportion of lead available for intestinal absorption. For several spices, the proportion of available lead was 49%, which means that about half of the lead that is ingested will be absorbed.
Lead absorption is higher after a fast of three hours or more, and skipping breakfast may contribute to higher blood lead levels in children.
People who have nutritional deficiencies, such as iron deficiency, also tend to absorb more lead and have higher blood lead levels. This is because our bodies compensate for the deficiency by producing more receptors to capture iron from foods. Lead takes advantage of the additional receptors to enter the body. Young children and pregnant women are at higher risk for developing iron deficiency, so there is good reason for vigilance about lead in the foods they consume.
Studies show that among children with lead poisoning in the U.S., contaminated spices were one of several sources of lead exposure. Studies that estimate blood lead levels from statistical models suggest that consuming 5 micrograms of lead or more from spices daily could substantially contribute to elevated blood lead levels.
For occasional or seasonal consumption, or lower levels of contamination, more research is needed to understand how lead in spices would affect lead levels in the blood.
For people who have other sources of lead in their homes, jobs or hobbies, additional lead from foods or spices may matter more because it adds to the cumulative dose from multiple exposure sources.
How to test for elevated blood lead levels
The Centers for Disease Control and Prevention recommends that children at risk for lead exposure get a blood lead test at 1 and 2 years of age. Older children can also get tested. Finger-prick screening tests are often available in pediatric offices, but results may need to be confirmed in venous blood if the screening result was elevated.
Adults in the U.S. are not routinely tested for lead exposure, but concerned couples who plan on having children should talk to their health care providers.
What to consider when using or buying cinnamon or other spices
If the product is on an FDA Alert or the Consumer Reports “don’t use” list, discard it.
Other questions to consider are:
- Does your household use spices frequently and in large amounts?
- Do young children or pregnant women in your household consume spices?
- Do you typically consume spices on breakfast foods or beverages?
If the answer to any of these questions is yes, then buy good-quality products, from large, reputable sellers. Think about using cinnamon sticks if possible.
And continue to enjoy spices!
Katarzyna Kordas, Associate Professor of Epidemiology and Environmental Health, University at Buffalo
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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.
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(Family Features) As people prepare to gather with family and friends this holiday season, it’s important to think about health and safety.
“With the holidays just around the corner, now is the perfect time to think about how you can help protect yourself from serious illness from flu, COVID-19 and RSV – and support your loved ones in doing the same,” said Dr. Rachel Levine, assistant secretary for health at the U.S. Department of Health and Human Services (HHS). “Vaccination is an important step in having a happy and healthy celebration.”
While preparing for holiday festivities, keep these recommendations in mind to help protect yourself from severe flu, COVID-19 and RSV.
Flu: Flu season usually peaks during the winter months, so now is a great time to get the 2024-25 flu vaccine. It’s recommended for people 6 months and older to lower their risk of infection or serious illness from the flu. In fact, people who skipped their flu shot last year were twice as likely to need medical help for the flu. The best time to get vaccinated is at least a couple of weeks before a holiday gathering. But getting vaccinated later in the season can still help. Encourage your family and friends to get the flu vaccine, too. Together you can create safer holiday celebrations.
COVID-19: Getting vaccinated against COVID-19 is also important for everyone ages 6 months and older. The updated COVID-19 vaccines offer the best protection against serious illness from the virus, especially for those at higher risk. This includes people with certain health conditions or older adults, which may include parents, grandparents and great aunts or uncles. By getting vaccinated, people of all ages can lower their risk of getting severely sick. In fact, young adults are at higher risk of developing Long COVID than older adults. However, staying up to date on your COVID-19 vaccines lowers your risk of Long COVID, too.
RSV: RSV can be especially risky for older adults and babies. That’s why everyone 75 and older, people 60-74 with certain health conditions or who live in a nursing home and pregnant people should get the RSV vaccine. Pregnant people should get the RSV vaccine at 32-36 weeks of pregnancy to help protect their newborns from severe RSV during their first six months of life.
As you prepare for the holidays, remember that prevention is the best way to keep from getting seriously sick from flu, COVID-19 and RSV. By getting vaccinated now, you can enjoy the holiday season with greater confidence and less risk of missing time together. Being vaccinated helps keep your symptoms milder if you get infected after vaccination so you can do the things you want to do with less risk of spreading infection.
Talk with your doctor about which vaccines are right for you as well as for any loved ones you help care for. Visit cdc.gov/RiskLessDoMore for more information on vaccines, or visit vaccines.gov to get started.
The Effects of Flu, COVID-19 and RSV on Different Populations
People who are Black, Hispanic or who live in rural areas may be at higher risk of severe illness from flu, COVID-19 and RSV than others. Getting vaccinated is the best protection from getting seriously sick from these viruses. According to the Centers for Disease Control and Prevention (CDC):
- Last flu season, Black adults were more than twice as likely as white adults to be hospitalized for flu.
- Last flu season, Hispanic adults were more likely than white adults to be hospitalized for flu.
- One in 3 adults living in rural areas have never been vaccinated against COVID-19. For people living in rural areas, health services may be far away. That can mean it takes some planning to get vaccinated. But being far from medical care also means it’s even more important to lower your risk of serious illness by getting vaccinated.
Photos courtesy of Shutterstock
SOURCE:
United States Department of Health and Human Services
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.
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Tome medidas para limitar el riesgo de enfermedad cardiovascular
(Family Features) En la última década se ha producido un aumento de factores de riesgo cardiovascular, como la hipertensión arterial no controlada, la diabetes y la obesidad, cada uno de los cuales aumenta el riesgo de desarrollar enfermedades cardíacas y accidentes cerebrovasculares. Estas tendencias están llevando a los investigadores a concluir que la prevalencia de las enfermedades cardiovasculares (ECV) seguirá aumentando.
Más del 60 % de los adultos estadounidenses tendrán algún tipo de ECV para 2050, según las proyecciones previstas de la American Heart Association, que celebra 100 años de servicio salvando vidas como la principal organización mundial sin fines de lucro dedicada a la salud del corazón y el cerebro de todos. Además, se espera que los costos totales relacionados con las ECV casi se tripliquen en ese período hasta alcanzar más de 1.8 trillones de dólares.
El aumento será impulsado por una población más anciana y diversa, pero estos factores de riesgo están aumentando incluso entre niños y adultos.
“Reconocemos que el panorama de la salud cardiovascular cambiará en las próximas tres décadas debido al tsunami que se avecina de aumentos en los costos de la atención médica, una población de mayor edad que vive más tiempo y un número cada vez mayor de personas de poblaciones de pocos recursos”, dijo la voluntaria de la American Heart Association, Karen E. Joynt Maddox, M.D., M.P.H., FAHA. “Aun así, estas siguen siendo las principales causas de muerte y discapacidad en Estados Unidos”.
Si bien se necesitan cambios sistemáticos continuos en la ciencia, las políticas y la atención de salud, la mayoría de las ECV se pueden prevenir a nivel individual. Usted puede ayudar a cambiar el rumbo de las terribles perspectivas de la ECV y, al mismo tiempo, mejorar su propia salud siguiendo y alentando a otros a seguir los “Life’s Essential 8” de la American Heart Association.
Coma mejor. Intente seguir un patrón de alimentación saludable en general que incluya alimentos integrales, frutas y verduras, proteínas magras, frutos secos, semillas y cocinar con aceite de oliva y de canola.
Manténgase activo. Los adultos deben realizar 2 horas y media de actividad física moderada o 75 minutos de actividad física vigorosa por semana. Los niños deben tener 60 minutos cada día, incluidos juegos y actividades estructuradas.
Deje el tabaco. El uso de productos que suministran nicotina por inhalación, que incluyen cigarrillos tradicionales, cigarrillos electrónicos y vaporizadores, es la principal causa de muerte evitable en los EE. UU.
Duerma bien. La mayoría de los adultos necesitan dormir entre 7 y 9 horas cada noche. Los niños de 5 años o menos necesitan entre 10 y 16 horas, incluidas las siestas; de 9 y 12 horas, en niños de 6 y 12 años, y entre 8 y 10 horas, entre los 13 y 18 años.
Controle el peso. Lograr y mantener un peso saludable tiene muchos beneficios. El índice de masa corporal es un indicador útil. El IMC óptimo es menor de 25, pero menor de 18.5 se considera bajo peso. Puede calcularlo en línea o consultar a un profesional de la salud.
Controle el colesterol. Los niveles altos de colesterol no HDL, o “malo”, pueden provocar enfermedades cardíacas. Su profesional de atención médica puede considerar el colesterol no HDL como el número preferido para monitorear, en lugar del colesterol total, porque se puede medir sin ayuno previo y se calcula de manera confiable entre todas las personas.
Controle el nivel de azúcar en sangre. La mayor parte de los alimentos que consume se convierten en glucosa (o azúcar en sangre) que su cuerpo utiliza como energía. Con el tiempo, los niveles altos de azúcar en sangre pueden dañar el corazón, los riñones, los ojos y los nervios.
Controle la presión arterial. Mantener su presión arterial dentro de rangos aceptables puede ayudarle a mantenerse saludable por más tiempo. Los niveles inferiores a 120/80 mmHg son óptimos. La presión arterial alta se define como una presión sistólica de 130 a 139 mm Hg (el número superior en una lectura) o una presión diastólica de 80 a 89 mm Hg (el número inferior).
Encuentre más formas de cuidar su salud en el nuevo año y más allá en heart.org.
Foto cortesía de Shutterstock
SOURCE:
American Heart Association
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