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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Lifestyle
Why the First Year Behind the Wheel is the Most Dangerous: Data Shows Teen Drivers 3 Times More Likely to be in Fatal Crash
Teen drivers are significantly at risk of fatal crashes, with those aged 16-19 being nearly three times more likely to be involved in accidents than older drivers. The first year of driving presents heightened dangers, but with proper preparation, including coaching, technology, and smart insurance, families can mitigate these risks and promote safety.
Why the First Year Behind the Wheel is the Most Dangerous: Data Shows Teen Drivers 3 Times More Likely to be in Fatal Crash
(Feature Impact) The driver’s license photo may be slightly awkward, but the milestone is unforgettable. For families, a newly licensed teen means independence, busy schedules and a new set of responsibilities.
Motor vehicle crashes remain one of the leading causes of death for U.S. teens, according to the Centers for Disease Control and Prevention (CDC). Data from the National Highway Traffic Safety Administration shows drivers ages 16-19 are nearly three times more likely to be involved in a fatal crash than drivers 20 and older, per mile driven.
The statistics are serious, but they’re also manageable.
“With the right preparation, teen driving doesn’t have to feel overwhelming,” said Susan Irace, manager, divisional claims at Mercury Insurance. “Experience is what young drivers are building. Parents can help shorten that learning curve with structure, technology and smart coverage decisions.”
Why the First Year Matters
Federal safety data shows crash risk is highest in a teen’s first year of independent driving. Night driving, teen passengers and distracted driving increase that risk – while seat belts, graduated licensing laws and supervised practice significantly reduce it.
In 2023, more than 2,800 teens ages 13-19 were killed in motor vehicle crashes nationwide, according to the CDC. However, teen crash rates have declined over time thanks to safer vehicles, graduated driver licensing programs and greater awareness of distracted driving.
Ways to Reduce Teen Driving Risk
The experts at Mercury Insurance encourage families to focus on preparation rather than panic.
1. Coach Early and Often
- Log supervised driving time in different conditions – highways, rain, nighttime
- Create a simple written driving agreement outlining expectations
- Limit teen passengers during the first year
- Make seatbelts non-negotiable
2. Let Technology Help
- Choose vehicles with safety features like automatic emergency braking and blind-spot monitoring
- Use telematics or safe-driving feedback tools to reinforce good habits
- Activate smartphone “Do Not Disturb While Driving” settings
3. Review Insurance Before the Keys Change Hands
- Add teens to your insurance policy promptly
- Revisit liability limits to protect family assets
- Ask about good student and driver training discounts
“Insurance is about preparation, not fear,” Irace said. “When families combine active coaching with the right coverage, they’re setting their teen up for safer miles ahead.”
Preparation Turns Risks into Confidence
The first solo drive is a milestone, but preparation determines what comes next. By pairing common-sense coaching with today’s vehicle safety technology and thoughtful insurance planning, families can support independence while managing risk responsibly.
For more teen driver safety tips and coverage guidance, visit MercuryInsurance.com/resources.
Photos courtesy of Shutterstock
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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.
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Last Updated on March 13, 2026 by Daily News Staff
(Feature Impact) To add charm to your yard, encourage local wildlife and give you a front-row seat to nature, building a birdhouse is a simple weekend project that checks all of those boxes.
Building a Birdhouse
Seasoned DIYers and first-timers alike can follow this step-by-step guide to create a functional, welcoming birdhouse.
Step 1: Choose the Right Design
Start by deciding what type of birds you’d like to attract. Different birds prefer different house sizes and entrance types. A simple, classic birdhouse design makes the project beginner-friendly and works well for common backyard birds like wrens, chickadees and bluebirds. In general, plan for at least a 1-1 2/2-inch entrance hole, a 5-by-5-inch interior space and 2 inches or more of roof overhang.
Step 2: Gather Materials and Tools
Most DIY birdhouses can be built with basic materials and tools you may already have at home, including untreated cedar or pine wood, screws or nails, wood glue, sandpaper and exterior-safe paint as well as a measuring tape, pencil, saw and drill.
Step 3: Measure and Cut Wood
Measure and cut wood to make the front panel, back panel, two side panels, floor and roof. Then sand all edges for smooth assembly.
Step 4: Drill Holes
Using a hole-saw bit, drill the entrance hole into the front panel. Position it a few inches below the roofline to keep predators out. Next, drill 2-3 small drainage holes in the floor piece to prevent water buildup and help keep the birdhouse dry.
Step 5: Assemble the Birdhouse
Attach the side panels to the back panel using screws or nails. Add the front panel then secure the floor piece, slightly recessed, so rainwater can drain. Attach the roof last, making sure it slopes slightly to allow water to run off.
Step 6: Paint the Exterior
If you plan to paint your birdhouse, stick to neutral, nature-inspired colors. Light browns, soft greens or white help regulate temperature and blend into the environment.
Step 7: Mount Your Birdhouse
Once dry, place your birdhouse in a quiet, sheltered spot away from heavy foot traffic. Mount or hang it 5-10 feet off the ground, facing away from prevailing winds.
Visit eLivingtoday.com for more DIY project inspiration.
Photo courtesy of Shutterstock
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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.
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Last Updated on March 11, 2026 by Daily News Staff
Shelia R. Cotten, Clemson University
What is the first thing you do in the morning after you awaken? Many people immediately check their phones for notifications of messages, alerts and social media updates by their social ties.
Ninety-seven percent of U.S. adults report owning a cellphone, with 90% reporting that they own a smartphone.
While some researchers and media outlets portray phone use as detrimental, the reality is that the effects of technology use, including phones, vary depending on multiple factors. These include the amount, type, timing and purpose of that use. What is best for one group may not be best for another when thinking about technology use.
As a researcher who studies technology use and quality of life, I can offer some advice to hopefully help you thrive in a phone-saturated world. Some people may struggle with how to effectively use smartphones in their daily lives. And many people use their phones more than they think they do or more than they would like at times.
1. Monitor your use on a weekly basis
If the hours per day are increasing, think about why this is the case and whether this increased use is helping or hurting your everyday activities. An aspect of digital literacy is understanding your usage patterns.
2. Consider how you can use these devices to make your life easier
Using a smartphone can help people access online information, schedule appointments, obtain directions, communicate through a variety of mechanisms and potentially be in constant contact with their social ties.
This availability and access to information and social ties can be beneficial and help people juggle work and family responsibilities. However, it may also be related to work intensification, information overload, decreased well-being and the blurring of work/nonwork boundaries.
Weighing the pros and cons of use may help you understand when your phone use is beneficial versus detrimental.
3. Silence nonessential notifications and alerts
Do you really need to know that an old friend from high school messaged you on Facebook at that particular moment?
4. Select particular times during the day for social media
Be deliberate about when you allow yourself to use your phone for social media and other activities. Knowing these times each day may help you concentrate as well as help you to use your phone in more useful and productive ways.
5. Avoid phone use at bedtime
Don’t look at your phone last thing before going to sleep or first thing when you awaken. Have you ever checked email one last time before going to sleep, only to find a message that gets your mind racing and ends up impeding your rest?
6. Choose when not to use your phone
Set times and situations when you are not going to use your phone.
Some of my research has shown that using your phone when in the presence of others who are not using devices, particularly older adults, can be perceived as rude, deter communication and induce distress. My colleagues and I termed this situation the physical-digital divide.
7. Find your own phone-use balance
Don’t compare yourself with others in terms of amount of use but be cognizant of when your use is beneficial versus perhaps leading you to feel stressed or distracted.
8. Moderate phone-as-distraction
Using your phone as a distraction is OK, but do it in moderation. If you find yourself constantly turning to your phone when you are bored or working on something that is hard, try to find ways to maintain your focus and overcome the challenges you are experiencing.
9. Set boundaries
Let your immediate social ties know that you are not going to be checking your phone constantly. While people often expect immediate responses when they message others, the reality is that the majority of messages do not need an immediate response.
10. Be a savvy consumer of online information
This is not exclusive to phones, but it is relevant given the proportion of people who report using their mobile phones and other digital devices to access news and social media. In the era of mis- and disinformation, being critical of information found online is a necessity.
These suggestions can help you to be more cognizant of how much you are using your phone as well as the reasons you are using it. It’s important for your well-being to be a critical consumer of technology and the information you glean from using your devices, particularly your ever-present mobile phone.
Shelia R. Cotten, Provost’s Distinuished Professor of Sociology, Anthropology and Criminal Justice and Communication, Clemson 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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