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

Published

1 year ago

August 12, 2023

Daily News Staff

Credit: UCSF
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

8 Ways to Live Healthier in 2025

Published

2 days ago

November 3, 2024

Daily News Staff

Take steps to limit risk for cardiovascular disease

(Family Features) The last decade has seen a surge in cardiovascular risk factors such as uncontrolled high blood pressure, diabetes and obesity, each of which raises the risks of developing heart disease and stroke. These trends are leading researchers to conclude that the prevalence of cardiovascular disease (CVD) will continue to rise.

More than 60% of U.S. adults will have some type of CVD by 2050, according to forecasted projections from the American Heart Association, which is celebrating 100 years of lifesaving service as the world’s leading nonprofit organization focused on heart and brain health for all. Additionally, total costs related to CVD are expected to nearly triple in that time to more than $1.8 trillion.

The increase will be driven by an older, more diverse population, but these risk factors are rising even among children and adults.

“We recognize the landscape of cardiovascular health will change over the next three decades because of the coming tsunami of rising health care costs, an older population living longer and increasing numbers of people from under-resourced populations,” said American Heart Association volunteer Karen E. Joynt Maddox, M.D., M.P.H., FAHA. “Yet these are still leading causes of death and disability in the U.S.”

While continued systematic changes are needed in science, policy and health care, the majority of CVD is preventable at an individual level. You can help turn the tide on the dire outlook of CVD while improving your own health by following and encouraging others to follow the American Heart Association’s “Life’s Essential 8.”

Quest for Living Healthier

Eat better. Aim for an overall healthy eating pattern including whole foods, fruits and vegetables, lean protein, nuts, seeds and cooking with olive and canola oils.

Be active. Adults should get 2 1/2 hours of moderate or 75 minutes of vigorous physical activity per week. Kids should have 60 minutes every day, including play and structured activities.

Quit tobacco. Use of inhaled nicotine delivery products, which includes traditional cigarettes, electronic cigarettes and vaping, is the leading cause of preventable death in the U.S.

Get healthy sleep. Most adults need 7-9 hours of sleep each night. Children require 10-16 hours for ages 5 and younger, including naps; 9-12 hours for ages 6-12; and 8-10 hours for ages 13-18.

Manage weight. Achieving and maintaining a healthy weight has many benefits. Body mass index is a useful gauge. Optimal BMI is less than 25, but less than 18.5 is considered underweight. You can calculate it online or consult a health care professional.

Control cholesterol. High levels of non-HDL, or “bad,” cholesterol can lead to heart disease. Your health care professional can consider non-HDL cholesterol as the preferred number to monitor, rather than total cholesterol, because it can be measured without fasting beforehand and is reliably calculated among all people.

Manage blood sugar. Most of the food you eat is turned into glucose (or blood sugar) your body uses as energy. Over time, high levels of blood sugar can damage your heart, kidneys, eyes and nerves.

Manage blood pressure. Keeping your blood pressure within acceptable ranges can keep you healthier longer. Levels less than 120/80 mm Hg are optimal. High blood pressure is defined as 130-139 mm Hg systolic pressure (the top number in a reading) or 80-89 mm Hg diastolic pressure (bottom number).

Find more ways to manage your health in the new year and beyond at heart.org.

Photo courtesy of Shutterstock

SOURCE:
American Heart Association

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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Health

Embrace the Hair and Raise Awareness: Join Us for No Shave November!

Published

4 days ago

November 1, 2024

Rod Washington

As autumn settles in and November draws near, it’s time to embrace a cause that calls for solidarity, conversation, and awareness: No Shave November! This year, the American Cancer Fund invites everyone—from athletes and coaches to military personnel, veterans, students, and everyday individuals—to join our efforts in raising awareness about cancer through facial hair.

What is No Shave November?

No Shave November is not just about letting your beard grow; it’s a powerful initiative aimed at promoting cancer awareness and encouraging conversations about prevention and early detection. Students, professionals, and community members can stand together to support the next generation’s campaign, “Screamin for Screenings.” By participating, we can unite our voices and show our commitment to fighting cancer.

Why Participate?

Cancer affects millions of people and their families every year. By participating in No Shave November, you can help bring the issue to the forefront and make a difference in your community. Not only do we aim to create a visual representation of support, but we also want to generate important conversations about cancer prevention. Growing facial hair becomes a symbol of solidarity and awareness, as each beard and mustache serves as a conversation starter for discussing vital topics related to health and wellbeing.

How You Can Get Involved

1. Sign Up!

Head over to our website and register for the campaign. Once signed up, you’ll receive a toolkit with resources to help you promote awareness among your friends and family. Join us here!

2. Spread the Word

Share your No Shave November journey on social media using the hashtag #NoShaveNovember and tag the American Cancer Fund on Instagram, Facebook, and X. Your posts can inspire others and create a ripple effect of awareness across platforms.

3. Fundraise

In addition to growing your facial hair, consider setting up a fundraising page to collect donations for cancer research and support services. Every contribution counts and can make a significant impact on the lives of those affected by cancer. Start fundraising here!

Make Every Hair Count

This November, let’s band together and show that every hair can represent strength, resilience, and awareness in the fight against cancer. Engaging with your community and initiating conversations about cancer prevention and screening can lead to life-saving actions. Whether you sport a full beard, a mustache, or just go for the stubble, remember—the goal is to spread awareness and support those affected by this disease.

Join us in our mission to make a difference, one hair at a time. Together, we can shine a light on the importance of cancer awareness, prevention, and early detection. Let’s get growing and make No Shave November a month to remember!

For more information about No Shave November and how to participate, please visit American Cancer Fund and be part of the movement that unites us all in the fight against cancer!

Together we can make a difference.

SOURCE American Cancer Fund

https://prnmedia.prnewswire.com/news-releases/join-us-for-no-shave-november-embrace-the-hair-and-raise-awareness-302281065.html

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Lifestyle

Some people love to scare themselves in an already scary world − here’s the psychology of why

Experiencing controlled fear can enhance social bonds, increase resilience, and offer psychological benefits, making horror entertainment a healthy distraction from scary real-life terrors.

Published

6 days ago

October 29, 2024

The Conversation

A controlled scary experience can leave you exhilarated and relaxed afterward. gremlin/E+ via Getty Images

Sarah Kollat, Penn State

Fall for me as a teenager meant football games, homecoming dresses – and haunted houses. My friends organized group trips to the local fairground, where barn sheds were turned into halls of horror, and masked men nipped at our ankles with (chainless) chain saws as we waited in line, anticipating deeper frights to come once we were inside.

I’m not the only one who loves a good scare. Halloween attractions company America Haunts estimates Americans are spending upward of US$500 million annually on haunted house entrance fees simply for the privilege of being frightened. And lots of fright fans don’t limit their horror entertainment to spooky season, gorging horror movies, shows and books all year long.

To some people, this preoccupation with horror can seem tone deaf. School shootings, child abuse, war – the list of real-life horrors is endless. Why seek manufactured fear for entertainment when the world offers real terror in such large quantities?

As a developmental psychologist who writes dark thrillers on the side, I find the intersection of psychology and fear intriguing. To explain what drives this fascination with fear, I point to the theory that emotions evolved as a universal experience in humans because they help us survive. Creating fear in otherwise safe lives can be enjoyable – and is a way for people to practice and prepare for real-life dangers.

Fear can feel good

Controlled fear experiences – where you can click your remote, close the book, or walk out of the haunted house whenever you want – offer the physiological high that fear triggers, without any real risk.

When you perceive yourself under threat, adrenaline surges in your body and the evolutionary fight-or-flight response is activated. Your heart rate increases, you breathe deeper and faster, and your blood pressure goes up. Your body is preparing to defend itself against the danger or get away as fast as possible.

This physical reaction is crucial when facing a real threat. When experiencing controlled fear – like jump scares in a zombie TV show – you get to enjoy this energized sensation, similar to a runner’s high, without any risks. And then, once the threat is dealt with, your body releases the neurotransmitter dopamine, which provides sensations of pleasure and relief.

In one study, researchers found that people who visited a high-intensity haunted house as a controlled fear experience displayed less brain activity in response to stimuli and less anxiety post-exposure. This finding suggests that exposing yourself to horror films, scary stories or suspenseful video games can actually calm you afterward. The effect might also explain why my husband and I choose to relax by watching zombie shows after a busy day at work.

four teens gleefully clutching each other behind bars in front of red splattered wall — Going through something frightening together – like a haunted house attraction – can be a bonding experience. AP Photo/John Locher

The ties that bind

An essential motivation for human beings is the sense of belonging to a social group. According to the surgeon general, Americans who miss those connections are caught up in an epidemic of loneliness, which leaves people at risk for mental and physical health issues.

Going through intense fear experiences together strengthens the bonds between individuals. Good examples include veterans who served together in combat, survivors of natural disasters, and the “families” created in groups of first responders.

I’m a volunteer firefighter, and the unique connection created through sharing intense threats, such as entering a burning building together, manifests in deep emotional bonds with my colleagues. After a significant fire call, we often note the improved morale and camaraderie of the firehouse. I feel a flood of positive emotions anytime I think of my firefighting partners, even when the events occurred months or years ago.

Controlled fear experiences artificially create similar opportunities for bonding. Exposure to stress triggers not only the fight-or-flight response, but in many situations it also initiates what psychologists call the “tend-and-befriend” system. A perceived threat prompts humans to tend to offspring and create social-emotional bonds for protection and comfort. This system is largely regulated by the so-called “love hormone” oxytocin.

The tend-and-befriend reaction is particularly likely when you experience stress around others with whom you have already established positive social connections. When you encounter stressors within your social network, your oxytocin levels rise to initiate social coping strategies. As a result, when you navigate a recreational fear experience like a haunted house with friends, you are setting the emotional stage to feel bonded with the people beside you.

Sitting in the dark with friends while you watch a scary movie or navigating a haunted corn maze with a date is good for your health, in that it helps you strengthen those social connections.

man and girl lean together in movie theater — Consuming lots of horror as entertainment may make some people more resilient in real life. Edwin Tan/E+ via Getty Images

An ounce of prevention = a pound of cure

Controlled fear experiences can also be a way for you to prepare for the worst. Think of the early days of the COVID-19 pandemic, when the films “Contagion” and “Outbreak” trended on streaming platforms as people around the world sheltered at home. By watching threat scenarios play out in controlled ways through media, you can learn about your fears and emotionally prepare for future threats.

For example, researchers at Aarhus University’s Recreational Fear Lab in Denmark demonstrated in one study that people who regularly consumed horror media were more psychologically resilient during the COVID-19 pandemic than nonhorror fans. The scientists suggest that this resilience might be a result of a kind of training these fans went through – they practiced coping with the fear and anxiety provoked by their preferred form of entertainment. As a result, they were better prepared to manage the real fear triggered by the pandemic.

When I’m not teaching, I’m an avid reader of crime fiction. I also write psychological thrillers under the pen name Sarah K. Stephens. As both a reader and writer, I notice similar themes in the books I am drawn to, all of which tie into my own deep-rooted fears: mothers who fail their children somehow, women manipulated into subservience, lots of misogynist antagonists.

I enjoy writing and reading about my fears – and seeing the bad guys get their just desserts in the end – because it offers a way for me to control the story. Consuming these narratives lets me mentally rehearse how I would handle these kinds of circumstances if any were to manifest in my real life.

Survive and thrive

In the case of controlled fear experiences, scaring yourself is a pivotal technique to help you survive and adapt in a frightening world. By eliciting powerful, positive emotions, strengthening social networks and preparing you for your worst fears, you’re better able to embrace each day to its fullest.

So the next time you’re choosing between an upbeat comedy and a creepy thriller for your movie night, pick the dark side – it’s good for your health.

Sarah Kollat, Teaching Professor of Psychology, Penn State

This article is republished from The Conversation under a Creative Commons license. Read the original article.