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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health and wellness
6 Ways to Build Lasting Healthy Habits
Starting on a path toward healthy habits is often easier than maintaining them long term. This year, you can avoid a major pitfall of healthy resolutions and build healthy habits that stick by working small, positive steps into your daily life.
(Family Features) Starting on a path toward healthy habits is often easier than maintaining them long term. This year, you can avoid a major pitfall of healthy resolutions and build healthy habits that stick by working small, positive steps into your daily life.
In fact, healthy habits are the first suggested treatment strategy for people whose blood pressure and cholesterol levels are creeping higher than normal, according to an American Heart Association scientific statement.
“The current guidelines for managing high blood pressure and cholesterol recognize that otherwise healthy individuals with mildly or moderately elevated levels of these cardiovascular risk factors should actively attempt to reduce these risks, and increasing physical activity is a great place to start,” said Bethany Barone Gibbs, Ph.D., chair of the statement writing group and chair of the department of epidemiology and biostatistics at West Virginia University School of Public Health.
These six ideas from the American Heart Association’s Healthy for Good Habit Coach can help.
Bust Common Habit-Building Myths
You may be surprised to learn the truth about creating and sticking to healthy habits. One myth is getting healthy means doing things you don’t like. Research shows positive emotions make habits stick, so set your intentions on something you enjoy. Another misconception is big results require big changes, which may lead to overly ambitious habits. However, the simpler the routine is, the more likely it is to become habit.
Work with Your “Brain Loops”
Your brain creates “loops” for habits made up of three things: a cue, a routine and a reward. Each time the loop is repeated, it becomes more routine and may become automatic. Knowing this, you can design cues for developing new, healthy habits, such as setting walking shoes by the bed to start a walking habit. The routine is putting on the shoes and walking around the block, and the reward is the pleasant sensations and brighter mood from a morning stroll.
Create Cues That Work for You
Most successful health habits begin with a cue. The cue can be external in your environment or internal in terms of your mindset. The more consistent the cue, the more likely it is to trigger the habit. Hacking your brain’s reminder system can help you remember your cue. Some examples of visual cues are placing a sticky note where you’ll see it often, keeping a water bottle on your desk or refrigerating fresh veggies at eye level.
Build a Routine That Supports Your Goals
Positive and consistent habits are important to achieve your personal goals. Small habits done consistently can add up to big results. To create a new healthy habit, think through the steps that could lead to your desired outcome. Ask yourself whether you want to do it, if it’s easy and if it’s high impact. It’s important to choose habits that make a difference and move you closer to your goals.
For example, if one of your goals is improving your heart health, a meaningful habit might be to move more. Increasing physical activity can help lower blood pressure and cholesterol along with many other health benefits, Gibbs said.
“Every little bit of activity is better than none,” she said. “Even small initial increases of 5-10 minutes a day can yield health benefits.”
Use Rewards to Make Habits Stick
Start by choosing a habit you enjoy that’s rewarding by itself. If you’re more of a dancer than runner, increase your physical activity with an upbeat dance class. You might also look for a more enjoyable version of a new habit, such as getting more fruits and veggies by sipping on a delicious smoothie.
Understand Resets are Part of the Process
New habits are experiments. If they don’t stick, you haven’t failed. Instead, you’ve learned what doesn’t work, which is useful. Get curious and ask yourself which part of the habit didn’t work for you. Maybe the cue was ineffective. Maybe the steps of the routine were too ambitious and you need to split them into smaller, easier steps. If you realize you don’t enjoy the habit, stop doing it and try something else.
Find more inspiration and ideas to jumpstart healthy habits this year at heart.org/habits.
Photos courtesy of Getty Images
SOURCE:
American Heart Association
STM Daily News is a vibrant news blog dedicated to sharing the brighter side of human experiences. Emphasizing positive, uplifting stories, the site focuses on delivering inspiring, informative, and well-researched content. With a commitment to accurate, fair, and responsible journalism, STM Daily News aims to foster a community of readers passionate about positive change and engaged in meaningful conversations. Join the movement and explore stories that celebrate the positive impacts shaping our world.
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Lifestyle
Get chronic UTIs? Future treatments may add more bacteria to your bladder to beat back harmful microbes
Researchers developed a biomaterial releasing beneficial E. coli to combat urinary tract infections by outcompeting harmful bacteria, aiming to reduce antibiotic resistance and manage chronic UTIs effectively.
Sarguru Subash, Texas A&M University
Millions of people in the U.S. and around the world suffer from urinary tract infections every year. Some groups are especially prone to chronic UTIs, including women, older adults and some veterans.
These infections are typically treated with antibiotics, but overusing these drugs can make the microbes they target become resistant and reduce the medicines’ effectiveness.
To solve this problem of chronic UTIs and antibiotic resistance, we combined our expertise in microbiology and engineering to create a living material that houses a specific strain of beneficial E. coli. Our research shows that the “good” bacteria released from this biomaterial can compete with “bad” bacteria for nutrients and win, dramatically reducing the number of disease-causing microbes.
With further development, we believe this technique could help manage recurring UTIs that do not respond to antibiotics.
Bringing bacteria to the bladder
For the microbes living in people, nutrients are limited their presence varies between different parts of the body. Bacteria have to compete with other microbes and the host to acquire essential nutrients. By taking up available nutrients, beneficial bacteria can stop or slow the growth of harmful bacteria. When harmful bacteria are starved of important nutrients, they aren’t able to reach high enough numbers to cause disease.
Delivering beneficial bacteria to the bladder to prevent UTIs in challenging, though. For one, these helpful bacteria can naturally colonize only in people who are unable to fully empty their bladder, a condition called urinary retention. Even among these patients, how long these bacteria can colonize their bladders varies widely.
Current methods to deliver bacteria to the bladder are invasive and require repeated catheter insertion. Even when bacteria are successfully released into the bladder, urine will flush out these microbes because they cannot stick to the bladder wall.
Biomaterials to treat UTIs
Since beneficial bacteria cannot attach to and survive in the bladder for long, we developed a biomaterial that could slowly release bacteria in the bladder over time.
Our biomaterial is composed of living E. coli embedded in a matrix structure made of gel. It resembles a piece of jelly about 500 times smaller than a drop of water and can release bacteria for up to two weeks in the bladder. By delivering the bacteria via biomaterial, we overcome the need for the bacteria to attach to the bladder to persist in the organ.
We tested our biomaterial by placing it in human urine in petri dishes and exposing it to bacterial pathogens that cause UTIs. Our results showed that when mixed in a 50:50 ratio, the E. coli outcompeted the UTI-causing bacteria by increasing to around 85% of the total population. When we added more E. coli than UTI-causing bacteria, which is what we envision for future development and testing, the proportion of E. coli increased to over 99% of the population, essentially wiping out the UTI-causing bacteria. Moreoever, the biomaterial continued releasing E. coli for up to two weeks in human urine.
Our findings suggest that E.coli could stick around and survive in the bladder for extended periods of time and successfully decrease the growth of many types of bacteria that cause UTIs.
Improving biomaterials
Our findings show that E. coli can not only control harmful bacteria it’s closely related to but also a broad range of disease-causing bacteria in humans and animals. This means scientists might not need to identify different types of beneficial bacteria to control each pathogen – and there are many – that can cause a UTI.
Our team is currently evaluating how effectively our biomaterial can cure UTIs in mice. We are also working to identify the specific nutrients that beneficial and harmful bacteria compete over and what factors may help beneficial bacteria win. We could add these nutrients to our biomaterial to be released or withheld.
This research is still at an early stage, and clinical uses are not in development yet, so if it does reach patients it will be well in the future. We hope that our technology could be refined and applied to control other bacterial infections and some cancers caused by bacteria.
Sarguru Subash, Assistant Professor of Veterinary Pathobiology, Texas A&M University
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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Lifestyle
Does Your Favorite Brand of Dark Chocolate Contain Dangerous Metals?
According to a recent article from Consumer Reports, there are some brands of Dark Chocolate that contain dangerous levels of lead, and cadmium.
Dark Chocolate
According to a recent article from Consumer Reports, there are some brands of Dark Chocolate that contain dangerous levels of lead, and cadmium.
Dark Chocolate has become popular due to studies suggesting that they are rich in antioxidants, which is beneficial to the heart, and it having low sugar properties that positively impact health.
The article, which was posted in mid December, states that 28 popular brands were tested, and that 23 of them contained high levels of the dangerous metals.
For more details, check out the article from Consumer Reports: https://www.consumerreports.org/health/food-safety/lead-and-cadmium-in-dark-chocolate-a8480295550/
STM Daily News is a vibrant news blog dedicated to sharing the brighter side of human experiences. Emphasizing positive, uplifting stories, the site focuses on delivering inspiring, informative, and well-researched content. With a commitment to accurate, fair, and responsible journalism, STM Daily News aims to foster a community of readers passionate about positive change and engaged in meaningful conversations. Join the movement and explore stories that celebrate the positive impacts shaping our world.
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