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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health and wellness
Stacking Healthy Habits for Progress, Not Perfection
Healthy Habits: Many struggle with building healthier habits due to unrealistic expectations rather than lack of motivation. The American Heart Association’s My Life Check tool offers personalized heart health insights, helping to set attainable goals. Simple lifestyle changes—focused on nutrition, movement, sleep, and stress management—can gradually lead to significant health improvements.
Last Updated on April 10, 2026 by Daily News Staff
(Feature Impact) Despite the best of intentions, it’s common for plans to build healthier habits to fall flat. Often, the culprit isn’t a lack of motivation or discipline; rather, it’s unrealistic expectations.
Overhauling your lifestyle requires a level of commitment that isn’t always practical. Understanding your personal health needs and the challenges you need to overcome can help give you a more realistic roadmap toward better health.
Tools to Guide You
Every plan needs a starting point and there are many reputable sources that can help guide you toward a plan that addresses your personal health needs.
For example, the American Heart Association introduced My Life Check, a simple, free tool to help individuals understand their heart health and what’s driving it. Users answer simple questions about their daily habits and health factors to get a personalized Heart Health Score in minutes.
The results are private and downloadable, giving you full control of your information. The tool turns big goals into small, specific actions you can start right away. Knowing your numbers relative to your heart health (and where you are in comparison to target ranges for optimal health) can help you decide how to build a better map to get you where you want to be.
While the report is customized to each individual, no personal data is stored and answers are only used to calculate health scores and provide personalized recommendations and practical steps to improve your health, so you can use your results to focus on what matters most to you. Every small step you take, such as moving more, eating smarter, sleeping better or managing stress, can add up over time.
Finding Your Path
Once you’re armed with data and know where you stand on your heart health numbers, small steps become clearer and more manageable. That knowledge makes it easier to choose one area to focus on, such as getting more sleep, taking daily walks or adding more color to your meals.
Healthy changes don’t need to be expensive or complicated. The best habits are ones that fit real life when every action you take moves you closer to your goals.
Eat Smart
Choose foods that help you feel your best, one meal at a time. Add more color to your plate and focus on balance, not restriction. Simple, affordable swaps can make a real difference.
Move More
Find movement that fits your life, such as a walk, a stretch or dancing while you cook. Every bit of activity counts and it all supports your heart and mind. Move for joy, not just for results.
Sleep Well
Rest is a foundation of good health, not a reward. Protect your bedtime routine and give your body the recovery it deserves. Notice how good sleep makes everything else easier.
Manage Stress
Check in with yourself regularly, both mentally and emotionally. Create simple moments to pause, breathe, laugh or step outside. Connection, kindness and calm all support a healthy heart.
Staying motivated and on track is also easier when you can check back in, see your progress and realize the steps you’re taking are making an impact. Checking in every few months to see how you can grow gives you the chance to celebrate your progress, learn from challenges and keep building lasting habits that feel good.
To get started with personalized tips to set your own health goals, visit heart.org/mylifecheck.
Photos courtesy of Shutterstock
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MINNEAPOLIS — The powerful new documentary Come Talk to ME is set to make its big-screen debut at the Minneapolis–Saint Paul International Film Festival (MSPIFF), marking a significant milestone for the independently produced film centered on Parkinson’s disease, communication, and human connection.
The 2026 festival, running April 8–19, will feature more than 200 films from around the world. Come Talk to ME is scheduled for two screenings, including a meaningful premiere on April 11—World Parkinson’s Day—followed by a second showing on April 14. Both screenings will take place at the Main Cinema at Saint Anthony Main in Minneapolis.
A Story About Communication and Connection
Directed by Deacon Warner and produced by Jackie Hunt Christensen, the documentary follows Christensen, her husband Paul, and a close-knit group of friends living with Parkinson’s disease.
The film explores how communication evolves as the disease progresses, highlighting the creative and deeply human ways individuals maintain relationships—with family, friends, and healthcare providers—even as traditional speech becomes more challenging.
Christensen, diagnosed with Parkinson’s at just 34, emphasizes that the film is ultimately about preserving connection:
“Having Parkinson’s does not mean that you stop loving, caring, and feeling… communication is everything.”
Innovative Use of AI Voice Technology
One of the film’s most groundbreaking elements is its use of AI-generated narration powered by ElevenLabs.
The filmmakers recreated Christensen’s voice using archival audio recorded shortly after her diagnosis in 2000. This AI-generated voice—nicknamed “JHC2K”—serves as the primary narrator, allowing Christensen to “speak” throughout the film in a way that would otherwise be difficult due to the progression of Parkinson’s.
Director Warner called the experience both innovative and deeply personal:
“To be part of [MSPIFF’s] rich history… while also utilizing cutting-edge AI technology to set us apart from other films is incredible.”
Festival Screenings and Accessibility
Come Talk to ME will screen twice during the festival:
- Saturday, April 11 (World Parkinson’s Day) – Early afternoon (time TBD)
- Tuesday, April 14 – Late afternoon (time TBD)
Ticket pricing:
- MSP Film Society Members: $11
- General Admission: $17 (+ online fee)
- Students: $10 (with ID)
In a move aligned with the film’s mission, the April 11 screening will offer free admission (donation-based) for individuals affected by Parkinson’s disease.
The venue also provides limited wheelchair seating on a first-come, first-served basis.
A Film Seeking Broader Impact
Beyond its festival debut, Come Talk to ME is actively seeking sponsors to expand its reach and impact. The filmmakers hope to bring the documentary to wider audiences, particularly within communities affected by Parkinson’s disease.
At its core, the film delivers a powerful message: even as physical abilities change, the need for connection—and the human drive to communicate—remains constant.
Why This Film Matters
As awareness of Parkinson’s disease continues to grow, Come Talk to ME stands out as both an emotional narrative and a technological milestone. By combining personal storytelling with AI innovation, the film offers a new way to understand life with Parkinson’s—and the enduring importance of being heard.
Source and Related Links
- Minneapolis–Saint Paul International Film Festival (MSPIFF) Official Site
- MSP Film Society Official Website
- World Parkinson’s Day – Official Information
- Parkinson’s Foundation – Resources & Support
- The Michael J. Fox Foundation for Parkinson’s Research
- ElevenLabs – AI Voice Technology Platform
STM Daily News’ Entertainment section delivers the latest on movies, television, music, pop culture, events, and industry buzz. From breaking news and trending stories to feature coverage and community-centered entertainment reporting, it keeps readers connected to what’s happening on screen, on stage, and beyond.
health and wellness
Heart Risks Go Beyond the Heart: Don’t Forget to Check Blood Sugar and Kidney Health
Heart Risks Go Beyond the Heart: Don’t Forget to Check Blood Sugar and Kidney Health
(Feature Impact) Diabetes and kidney disease are major risk factors for heart disease, yet many cases are undiagnosed. In fact, most people don’t realize their heart, kidney and metabolic health – how the body creates, uses and stores energy – are connected. Understanding these connections can help you take steps toward protecting your long-term health.
Cardiovascular-kidney-metabolic (CKM) syndrome is a health condition that includes heart disease, kidney disease, diabetes and obesity. Many people don’t realize they’re at risk, though, because they aren’t aware of health risks beyond the heart. Almost 1 in 4 U.S. adults with diabetes are unaware they have it, according to a 2026 statistics update from the American Heart Association. In addition, data from the Centers for Disease Control and Prevention shows that as many as 9 in 10 adults with chronic kidney disease don’t know they’re living with the condition.
Learning about CKM syndrome can be a helpful step in understanding your overall health picture.
How are CKM conditions connected?
Heart disease, kidney disease and diabetes have shared risk factors – including high blood pressure, cholesterol and blood sugar; excess weight; and reduced kidney function – and they’re closely linked. Having one condition often increases the likelihood of developing the others.
“We are encouraging people to become aware of the connection between conditions so they and their health care team can think about their overall health beyond individual conditions,” said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association, executive director of the Katz Institute for Women’s Health and senior vice president of women’s health at Northwell Health. “Understanding the connection helps you better prevent complications through lifestyle changes and appropriate treatment.”
The biggest health threats from CKM syndrome are disability and death from heart disease and stroke, which make up the “cardiovascular” part of CKM. The “metabolic” part includes diabetes and obesity. Kidney disease is closely linked with both metabolic and cardiovascular diseases.
How common is CKM syndrome?
CKM-related risks are common. Nearly 90% of U.S. adults have at least one risk factor for CKM syndrome. The 2026 statistics report showed about half of all U.S. adults have high blood pressure, about 1 in 3 has high total cholesterol, more than half have prediabetes or diabetes, about 1 in 7 has kidney disease and more than half have a high waist circumference.
These risks often develop slowly, with few or no symptoms at first, but you can stay informed. Rosen emphasizes regular screening of your cardiovascular, kidney and metabolic health, which can catch problems early.
“Due to the current risk factor rates, everyone could benefit from being screened this way,” she said.
Regular check-ins with your health care team can offer a clearer picture of your CKM health. They can check your:
- Blood pressure
- Cholesterol panel (total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides)
- Blood glucose (blood sugar), measured in either the short term as fasting glucose or long term as A1C
- Body weight and size, measured by body mass index and waist circumference
- Kidney function, using both UACR and eGFR
These results can be used in the PREVENT online calculator to estimate your risk for cardiovascular disease over the next 10 or 30 years. CKM syndrome can often be prevented and improved with healthy daily habits like those in Life’s Essential 8 and science-based treatments.
The CKM Health Initiative was introduced by the American Heart Association to raise awareness of the connections between CKM syndrome conditions and improve diagnosis rates. It’s supported by founding sponsors Novo Nordisk and Boehringer Ingelheim, supporting sponsors Novartis Pharmaceuticals Corporation and Bayer, and champion sponsor DaVita.
Visit Heart.org/myCKMhealth to learn more about CKM health, including screening and treatment options.
SOURCE:
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