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.”
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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.
Swisse Launches Glam Bites: Zero-Sugar Beauty Gummies Designed for Busy Routines
Swisse launches Glam Bites: delicious beauty gummies with zero sugar, no sugar alcohols, and no artificial flavors, colors, or sweeteners—designed to support beauty from within.
Swisse Launches Glam Bites: Zero-Sugar Beauty Gummies Designed for Busy Routines
Swisse, the premium supplement brand under Health & Happiness (H&H) Group and a Certified B Corp, is kicking off 2026 with a new way to support “beauty from within.” The company just introduced Swisse Beauty Glam Bites, a line of zero-sugar beauty gummies made with science-backed ingredients—without the usual “junk” found in many gummy supplements. Positioned for today’s always-on lifestyle, Glam Bites aims to make daily self-care feel less like another task and more like a quick, enjoyable habit: bite, nourish, and glow.
What makes Glam Bites different?
Gummy supplements are popular, but they often come with tradeoffs—added sugars, sugar alcohols, artificial flavors, or ingredients that don’t align with cleaner-label preferences. Swisse is leaning into the opposite approach. According to the company, Glam Bites are crafted with:
Zero sugar
No sugar alcohols
No artificial flavors, colors, or sweeteners
Gluten-free
Free from major allergens (milk, eggs, fish, crustacean shellfish, peanuts, wheat, soybeans, sesame)
That “clean but still tasty” promise is a big part of the launch—especially as more shoppers look for supplements that fit into wellness routines without feeling like a compromise.
A beauty routine that starts from the inside
Swisse is framing Glam Bites as a simple daily add-on that supports skin, hair, and nails through targeted micronutrients. Leading dietitian Dana A. White highlighted the brand’s approach in the announcement, noting that Glam Bites deliver “powerful, science-driven beauty benefits” through a precisely balanced blend of nutrients—while keeping the formula free from artificial colors, flavors, and sweeteners.
The Glam Bites lineup (available now)
Swisse launched Glam Bites in three formulas, each with its own ingredient blend and naturally flavored profile.
1) Hair Skin Nails Glam Bites
Price/Count: $19.99 (60 count)
Key ingredients: Biotin, Zinc, Bamboo Extract
What it supports: Stronger hair and nails, plus skin firmness and elasticity*
Flavor: Blood orange (naturally flavored)
2) Glow Skin Glam Bites
Price/Count: $24.99 (60 count)
Key ingredients: Hyaluronic Acid, Vitamins C & E, Sea Moss, Hydrolyzed Marine Collagen Peptides
What it supports: Collagen production, improved elasticity, and a stronger skin barrier*
Flavor: Blueberry lavender (naturally flavored)
3) Skin Defense Glam Bites
Price/Count: $24.99 (60 count)
Key ingredients: Astaxanthin, L-Glutathione, Green Tea Extract
What it supports: Healthy aging, even skin tone, and antioxidant protection against environmental stressors*
Flavor: Raspberry green tea (naturally flavored)
Why gummies—and why now?
Swisse is launching Glam Bites at a time when gummies are increasingly becoming the preferred supplement format for younger consumers. The company cited research showing:
45% of Gen Z and 31% of millennials favor gummy supplements.
74% of U.S. personal care buyers agree that skin health reflects overall health.
In other words: the market is shifting toward convenience, better taste, and wellness products that connect beauty with whole-body health.
A global wellness brand expanding its portfolio
Swisse was founded in Australia in 1969 and has grown into a global wellness name known for premium supplements made with ingredients backed by scientific research and produced under world-class manufacturing standards. With Glam Bites, the brand is clearly betting on a “cleaner gummy” future—one that fits modern routines and modern label expectations.
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
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How C-reactive protein outpaced ‘bad’ cholesterol as leading heart disease risk marker
C-reactive protein (CRP) is a key inflammation marker that can predict heart attack and stroke risk—often better than LDL cholesterol. Here’s why it matters.
C-reactive protein is created by the liver in response to infections, tissue damage, chronic inflammatory states from conditions like autoimmune diseases, and metabolic disturbances like obesity and diabetes. Essentially, it is a marker of inflammation – meaning immune system activation – in the body. C-reactive protein can be easily measured with blood work at the doctor’s office. A low C-reactive protein level – under 1 milligram per deciliter – signifies minimal inflammation in the body, which is protective against heart disease. An elevated C-reactive protein level of greater than 3 milligrams per deciliter, signifies increased levels of inflammation and thus increased risk for heart disease. About 52% of Americans have an elevated level of C-reactive protein in their blood. Research shows that C-reactive protein is a better predictive marker for heart attacks and strokes than “bad,” or LDL cholesterol, short for low-density lipoprotein, as well as another commonly measured genetically inherited biomarker called lipoprotein(a). One study found that C-reactive protein can predict heart disease just as well as blood pressure can.
Why does inflammation matter in heart disease?
Inflammation plays a crucial role at every stage in the development and buildup of fatty plaque in the arteries, which causes a condition called atherosclerosis that can lead to heart attacks and strokes. From the moment a blood vessel is damaged, be it from high blood sugar or cigarette smoke, immune cells immediately infiltrate the area. Those immune cells subsequently engulf cholesterol particles that are typically floating around in the blood stream to form a fatty plaque that resides in the wall of the vessel. This process continues for decades until eventually, one day, immune mediators rupture the cap that encloses the plaque. This triggers the formation of a blood clot that obstructs blood flow, starves the surrounding tissues of oxygen and ultimately causes a heart attack or stroke. Hence, cholesterol is only part of the story; it is, in fact, the immune system that facilitates each step in the processes that drive heart disease.Fatty plaque buildup in the arteries causes a blockage that starves tissues of oxygen and can lead to a heart attack or stroke.wildpixel/iStock via Getty Images Plus
Does cholesterol still matter for heart disease risk?
Though cholesterol may not be the most important predictor of risk for heart disease, it does remain highly relevant. However, it’s not just the amount of cholesterol – or more specifically the amount of bad, or LDL, cholesterol – that matters. Two people with the same cholesterol level don’t necessarily have the same risk for heart disease. This is because risk is determined more so by the number of particles that the bad cholesterol is packaged into, as opposed to the total mass of bad cholesterol that’s floating around. More particles means higher risk. That is why a blood test known as apolipoprotein B, which measures the number of cholesterol particles, is a better predictor of risk for heart disease than measurements of total amounts of bad cholesterol. Like cholesterol and C-reactive protein, apolipoprotein B is also influenced by lifestyle factors like exercise, weight loss and diet. Nutrients like fiber, nuts and omega-3 fatty acids are associated with a decreased number of cholesterol particles, while increased sugar intake is associated with a larger number of cholesterol particles. Furthermore, lipoprotein(a), a protein that lives in the wall surrounding cholesterol particles, is another marker that can predict heart disease more accurately than cholesterol levels. This is because the presence of lipoprotein(a) makes cholesterol particles sticky, so to speak, and thus more likely to get trapped in an atherosclerotic plaque. However, unlike other risk factors, lipoprotein(a) levels are purely genetic, thus not influenced by lifestyle, and need only be measured once in a lifetime.
What’s the best way to prevent heart disease?
Ultimately, heart disease is the product of many risk factors and their interactions over a lifetime. Therefore, preventing heart disease is way more complicated than simply eating a cholesterol-free diet, as once thought. Knowing your LDL cholesterol level alongside your C-reactive protein, apolipoprotein B and lipoprotein (a) levels paints a comprehensive picture of risk that can hopefully help motivate long-term commitment to the fundamentals of heart disease prevention. These include eating well, exercising consistently, getting adequate sleep, managing stress productively, maintaining healthy weight and, if applicable, quitting smoking.Mary J. Scourboutakos, Adjunct Assistant Professor in Family and Community Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University This article is republished from The Conversation under a Creative Commons license. Read the original article.
How to reduce gift-giving stress with your kids – a child psychologist’s tips for making magic and avoiding tears
Reduce gift-giving stress with kids: A child psychologist shares practical rules for stress-free gift giving with kids—how many gifts to give, what holds attention, and how to avoid holiday tears.
’Tis the season … for gift-buying stress. Photo by Ryan Miller/Invision/AP
How to reduce gift-giving stress with your kids – a child psychologist’s tips for making magic and avoiding tears
Angela J. Narayan, University of Denver As a child, I loved being the center of attention. So it was a problem when my baby brother was born a day before my birthday. For years, I would beg my parents for a birthday gift “one day early.” My laid-back brother remembers thinking, “I don’t care about presents. Just give her mine!” As an associate professor and child psychologist at the University of Denver who studies child development and parenting, I’ve come to learn about these types of challenges associated with gift giving. The holidays, while a magical time, can also be stressful. Society places an expectation on parents to buy gifts, regardless of their financial circumstances, and children themselves often feel a variety of complex emotions. How children react to getting presents is partially linked to temperament, which is the variety of ways that children experience, perceive and interact with the world. Temperament is the precursor to personality – some people are introverts, while others are extroverts. Temperament is partially heritable. That means an introverted parent who feels social pressure to buy many gifts for their shy and easily overwhelmed child may be inadvertently causing stress. Faced with this holiday conundrum, I’m often asked questions like “Is there a magic number of gifts to give my kids?” or “What gifts will hold my child’s attention the longest?” While there isn’t an easy answer to either question, these tips and tricks can help parents be more thoughtful and intentional about gift giving, especially for children who are young.
The age rule
Young children cannot focus on a lot of things at once. A good rule of thumb is that a 1-year-old can focus only on one thing at a time. A 2-year-old can maybe focus on two things at most, and a 3-year-old maybe three things, and so on. Stop at five. Very few children actually need more than five gifts, so feel free to go lower.
The attention rule
I have often searched for the magical gift that will keep my children occupied for hours, and so far I haven’t found it. What I have found is that my children – ages 5 and 7 – get excited about the things that I get excited about. So I try to buy things that I think are fun. Ask yourself what you would like to play with if you got to be a child again. I bet your children would be eager to join you in those things.
The games rule
Card and board games are great gifts, often inexpensive, fun for many ages – excepting babies, of course – and capable of holding attention for a long time. Plus, they usually don’t take up much storage space. I love giving my kids games that are not only fun but also teach them helpful skills. Collaborative games for preschoolers and early school-age children like the Fairy Game and Outfoxed teach problem-solving, teamwork and early reasoning skills. Games for elementary-age children, such as Sorry and Battleship, teach kids how to manage difficult situations, like not always being in the lead, being a good sport even if you’re behind, and losing gracefully. Timeless card games like Uno and Memory, and newer ones like Sleeping Queens and Exploding Kittens, are great for using working memory, thinking flexibly, persisting and strategizing. Most importantly, playing games together supports positive family time, which is an excellent antidote to stress, bad moods or boredom.
The pressure rule
Imagine the holiday experience through the eyes of each of your children. Some children relish receiving gifts, like I did. Others, however, may feel self-conscious, overwhelmed by the sensory overload – all the textures, commotion and bright colors, not to mention people staring at them. The elements of surprise combined with the unspoken social pressure to be gracious and well regulated are challenging for any young child. We expect small children to contain their excitement, delay gratification and react positively to the surprise. And then come up with a polite response. These are all complex requests, rarely directly or explicitly taught. It’s no wonder that many children show negative emotions, have tantrums, or even just say, “I’m tired!” during holiday celebrations. That’s why beyond the precise nature of “the perfect gift,” we shouldn’t lose sight of what we should be doing. And that is investing in togetherness and helping kids learn skills like being patient and taking turns, strengthening memory capacities, planning ahead, not giving up, and that being a team player will pay off later. These skills pave the way for longer sustained attention, focus and concentration, as well as confidence. My 7-year-old is becoming a skillful chess player because we have taught him the rules and strategy and helped him practice. Maybe this is the real magical gift – not the purchase itself, but the decision to invest in time with your child early. Angela J. Narayan, Associate Professor, Clinical Child Psychology Ph.D. program, University of Denver This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Mary J. Scourboutakos, Adjunct Assistant Professor in Family and Community Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University This article is republished from The Conversation under a Creative Commons license. Read the original article.
