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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(Family Features) If you have Crohn’s disease or ulcerative colitis, a clinical trial may be an option for you. Clinical trials are necessary for finding new ways of preventing, detecting or treating these diseases and others. To learn more about inflammatory bowel disease clinical research, visit crohnscolitisfoundation.org/clinical-trials-community and consider resources from the Crohn’s & Colitis Foundation that can provide information on types of clinical trials, what to expect when participating in a clinical study, questions to ask your doctor, stories from clinical trial participants, how to find a clinical trial and more.
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Crohn’s & Colitis Foundation
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(Family Features) A walk isn’t just good for your body; it’s a simple, powerful way to care for your mind and soul. Physical activity, like walking, reduces stress, boosts mood and promotes overall well-being. Yet physical activity levels in the United States continue to decline, a trend threatening both mental and physical health.
Less than half of adults and fewer than 1 in 5 children in the U.S. get the recommended amount of physical activity needed for heart health, according to the American Heart Association’s 2025 Heart & Stroke Statistical Update.
National recommendations call for children to get at least one hour of physical activity each day, but the latest statistics show less than 19% of children in the U.S. achieve that target. Meanwhile, less than half of adults get the recommended 150 minutes or more of weekly physical activity.
What’s more, according to data from a National Health and Nutrition Examination Survey, 1 in 4 U.S. adults sits for longer than eight hours each day, which can have negative consequences on physical and mental health.
For decades, the American Heart Association has championed the importance of physical activity in communities across the country through events like National Walking Day on Wednesday, April 2. These tips and information can help you understand how a brisk walk can make a world of difference for heart health and mental clarity.
Benefits of Physical Activity
Staying active is one of the best ways to keep your mind and body healthy.
The physical health benefits may be obvious, but research suggests physical activity can also help bring more joy to your life. According to the 2019 Physical Activity Guidelines for Americans, people who get the recommended amount of physical activity are less likely to experience depression.
Regular physical activity enhances your mood, sharpens your mind, improves sleep and boosts overall well-being, all while reducing the risk of disease and depression and increasing both the quality and longevity of life.
How to Be More Physically Active
Exercise as simple as a brisk walk can put a major spring in your step. It can even energize you to finish other tasks at hand, whether it’s cooking or running errands. Give your daily physical activity level a boost with these tips:
- Exercising outdoors is a great way to get moving. Spending time outdoors has been shown to reduce stress, promote a sense of belonging and improve mood. It’s even better if you can enjoy the sunshine outside, which can improve mood, boost your immunity and help you get some vitamin D.
- Invite a family member or friend along with you. It’s good for them, it’s good for you and it’s good company all around.
- Instead of wondering if you’ll move today, explore how you’ll move. A walk, a dance or a stretch all count.
Getting Pets Involved
Pets are part of your family, and they can help you get healthy together. Pets provide a fun reason to spend more time outside and get the exercise needed to reduce the risk of disease later in life.
Getting moving along with your pet adds more exercise to your routine, which means living longer, reducing risk of dying from heart attack or stroke, reducing risk of diabetes, reducing stress and even boosting your overall happiness and well-being.
Exercising with your pet can also mean enjoying more socializing. You may find yourself meeting other dog owners in your area on a walk or at the dog park.
Learn more about how simple habits like walking can support your overall health at heart.org/MoveMore.
Photos courtesy of Shutterstock
SOURCE:
American Heart Association
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Food and Beverage
Add This Superfruit to Your Menu for Heart-Healthy Meals: Make recipes nutritious and delicious with avocados
(Family Features) It’s no secret that adding greens to your menu – morning, noon and night – can go a long way toward healthier eating habits. While most people think of lettuce, kale, spinach, cucumbers and Brussels sprouts, don’t forget avocados are a superfruit you can use to add good fats and great taste to recipes throughout the day.
As a versatile fruit with naturally good fats and nearly 20 vitamins and minerals, avocados have become a household staple. Avocados From Mexico is a national supporter of the American Heart Association’s Healthy for Good Initiative – Eat Smart Program, encouraging people to incorporate a variety of fruits, vegetables and other heart-healthy foods into their meals.
By supporting this initiative, Avocados From Mexico is helping to raise awareness about the importance of making smart nutrition choices. The brand’s “Good Fats Meet Great Taste” campaign, featured at select Kroger locations, highlights the importance of balanced nutrition and fresh food choices as part of an overall heart-healthy lifestyle.
Avocados provide a good source of naturally unsaturated fats, which can be part of a heart-healthy eating pattern when consumed in place of saturated fats. A well-balanced diet that includes nutrient-rich foods like avocados, whole grains, lean proteins and fiber-rich vegetables can support overall heart health. In addition to good fats, avocados are also a good source of fiber, with 3 grams per one-third of a medium avocado.
If you’re looking for an easy yet tasty way to add more avocados to your family’s menu, this Avocado, Brussels Sprout, Kale and Date Salad provides a delicious introduction to the superfruit. Loaded with greens and fit for sharing with a crowd, you can do your part to bring avocados to your nearest and dearest, neighbors or anyone you’re hosting for a fresh, better-for-you meal.
The best part: This heart-healthy dish comes together in a snap. Just process the homemade dressing featuring dates, Dijon mustard and apple cider vinegar. Then toss Brussels sprouts, kale, red onion, pistachios and, of course, avocados before combining with the dressing.
Finally, serve with shaved Parmesan cheese on the side (so guests who prefer to avoid dairy can do so) and enjoy for a fresh meal that’s equal parts delicious and nutritious. Sliced avocados are the star of the dish, with naturally good fats and nearly 20 vitamins and minerals, making this an always good, super fun recipe and a way to begin making smarter food choices.
Discover more ways to add heart-healthy meals to your menu by visiting AvocadosFromMexico.com/avocado-nutrition.
Avocado, Brussels Sprouts, Kale and Date Salad
Servings: 8
Dressing:
- 1 tablespoon lemon juice
- 2 tablespoons apple cider vinegar
- 4 dates, pitted, softened
- 2 teaspoons Dijon mustard
- 1/4 cup olive oil
- 2 Avocados From Mexico, sliced
- 6 cups Brussels sprouts, shaved or shredded
- 3 cups lacinto (dinosaur) kale, shredded
- 1 cup red onion, sliced
- 1/2 cup pistachios (or pumpkin seeds), shelled
- reduced-fat (sharp) Parmesan cheese, shaved or grated, for topping (optional)
- To make dressing: In food processor, process lemon juice, apple cider vinegar, pitted dates and mustard. Slowly add olive oil to combine.
- To make salad: In large salad bowl, combine avocados, shaved Brussels sprouts, kale, red onion and pistachios. Drizzle salad dressing evenly over greens and toss until well-coated.
- Serve with shaved Parmesan cheese, if desired.
SOURCE:
Avocados From Mexico
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