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)
Health
How Young Adults Can Build a Healthier Future
Bridging national service and public health, the initiative supports a diverse group of early career professionals working to address today’s public health challenges in a range of roles
(Family Features) Shaping the future of public health into an equitable one means ensuring all people and communities have access to the health care and resources they need to live well. The nation requires a strong, diverse public health workforce to accomplish that goal.
That’s why AmeriCorps and the Centers for Disease Control and Prevention launched Public Health AmeriCorps – to support the recruitment, training and development of early career public health workers who can serve their local communities.
Bridging national service and public health, the initiative supports a diverse group of early career professionals working to address today’s public health challenges in a range of roles, including:
- Health education and training
- Community outreach and engagement
- System navigation, referrals and linkage to care
- Research, data collection, analysis and assessment
What Members are Saying
Everyone was impacted by the COVID-19 pandemic – including Dionne Johnson, who lost a loved one to the virus.
“I had a family member die from COVID-19, and it really touched me,” Johnson said. “That gave me the passion and lit the fire under me to actually pursue a career in public health.”
Now, Johnson is realizing her dreams of transforming public health in her community. In her work, she wants to teach people in Black and brown communities how they can learn to be healthy and advocate for themselves.
Another member, Jaiden Singh, is the son of immigrants. Singh launched a promising career in public health so he can give back to the community where he grew up.
“Being a part of the organization not only has really supplemented my education that I’m working toward in public health and policy, it has also given me the opportunity to do work that I am really passionate about in a community that I have known all my life and really do love,” Singh said. “I would highly recommend being a part of this really valuable and inspiring community.”
Action That Creates Impact
The diverse work of Public Health AmeriCorps benefits not only program members but also the communities they serve. As examples of the program at work, members have:
- Provided overdose rescue education, raised awareness about opioid use disorder and harm reduction strategies and distributed overdose rescue kits containing naloxone (an overdose-reversing nasal spray).
- Held back-to-school COVID-19 testing events, distributed early childhood health education and built community gardens in underserved communities.
- Participated in a community mental health crisis intervention system to assess, stabilize and link people in crisis to follow-up care and services.
- Supported elementary schools as part of a dental hygiene program that sends out staff and volunteers to provide free teeth cleanings to students.
Learn More and Apply
If you want to start your career and make a difference in public health, consider member benefits such as:
- Education awards to apply to higher education or student loan forgiveness
- Student loan deferment and forbearance
- Living allowance
- Hands-on experience
- Training from experts
Visit AmeriCorps.gov/PublicHealth for a list of opportunities to serve and contact your desired opportunity by phone or email to learn more and apply. You can also subscribe to the newsletter to learn more about the initiative.
SOURCE:
AmeriCorps
Lifestyle
Saving a Life This Summer: Ways to Step Up Safety Practices
Regardless of where you are, summer is a reminder that emergencies like cardiac arrest can happen anywhere. Take the safety of those around you into your own hands this summer with this checklist.
(Feature Impact) The busy summer season can take you almost anywhere – baseball fields, backyard cookouts, long workdays or road trips across the country. Regardless of where you are, summer is a reminder that emergencies like cardiac arrest can happen anywhere.
More than 350,000 out-of-hospital cardiac arrests occur in the United States each year, and 90% of people will not survive, according to the American Heart Association, a nonprofit organization devoted to changing the future for a world of healthier lives for all. Sudden cardiac arrest can happen anytime, anywhere. People often hesitate to step in. In fact, nearly 2 out of 3 adults believe CPR can only be performed by medical professionals. This mistaken belief can cost lives and contributes to the low survival rate.
Ordinary people have extraordinary power. You don’t need to wear scrubs or have a medical background to save a life – you just need the courage to act.
Take the safety of those around you into your own hands this summer with this checklist.
Plan Ahead
Summer is often a time for welcome disruptions, including vacations, camps, sports and parties. Before traveling or attending events, check if your destination has a cardiac emergency response plan, which establishes specific steps to reduce death from cardiac arrest in any setting, from schools and community organizations to workplaces and sports facilities.
Learn CPR
Cardiac arrest can happen anywhere: at home, at work, in schools, at a soccer game or on vacation. When it happens, the first chance for survival often rests with the people nearby.
Anyone can be the difference before professional help arrives. The power to save a life is in your hands. CPR is a human responsibility, not just a medical skill. When friends, family or even strangers step in during cardiac emergencies, survival rates can double or even triple.
Hands-Only CPR for adults consists of two easy steps:
- Call 9-1-1 or shout for someone else to call.
- Push hard and fast in the center of the chest to the beat of a familiar song that’s 100-120 beats per minute, such as “Stayin’ Alive” by the Bee Gees.
Share Resources with Your Family and Community
Once you’ve learned simple, two-step Hands-Only CPR, share resources with your community to help expand the American Heart Association’s Nation of Lifesavers. Raising awareness with family, neighbors and colleagues can help people feel confident in the face of an emergency.
Families can watch short instructional videos that demonstrate the life-saving steps for adults as well as techniques for infants and children.
Travelers can also get trained in about 5 minutes with a Hands-Only CPR Kiosk, located in many airports and public spaces across the country.
To find more information about learning CPR, visit Heart.org/Nation.
Summer Safety Tips
In addition to learning CPR and sharing valuable resources with your family and community, consider these ways to keep yourself and loved ones safe throughout the summer months.
- Stay Hydrated: High temperatures can quickly lead to dehydration and heat-related illness. Drink water regularly throughout the day, especially during outdoor activities, and pack extra water when away from home.
- Protect Your Skin: Hats, sunglasses and lightweight clothing can protect skin from sun exposure, but it’s important to use broad-spectrum sunscreen and reapply every 2 hours.
- Swim with a Buddy: Hopping in a pool, lake or ocean is a hallmark of summer but can be dangerous without precautions. Never swim alone and ensure children are always supervised by an adult near water.
- Identify the Locations of Safety Equipment: When attending camps, heading to a sporting event or enjoying the pool or beach, identify where lifeguards, AEDs and emergency exits are located. Knowing where to find help can save valuable time when every second counts.
- Practice Grill Safety: Some of your most memorable summer moments may happen during a backyard barbecue or cookout, and it’s important to keep those gatherings safe. Use grills away from homes, decks and dry grass. Never leave them unattended while cooking, and be sure kids and pets stay at a safe distance from hot surfaces.
Saving a Life Within 1 Year of Learning CPR
On a chilly Tuesday, dawn was breaking as Matthew Lynch reached his highway exit, but traffic was backed up at a particular intersection. He waited through three cycles before finally getting close enough to see the holdup: a stalled SUV.
While most cars buzzed by, Lynch moved slowly and peered into the vehicle. He saw people inside and parked his sedan, flipped on the hazard lights and ran to the stalled SUV. As he knocked on the driver’s window, there was no response. The doors were locked. Two people – a male driver and female passenger – were unresponsive.
Lynch ran back to his own car and called 9-1-1 before managing to open the driver’s side door. He discovered the driver was not breathing normally, signaling to Lynch he’d need to start CPR – which he’d learned 10 months earlier during a training session he’d helped organize for a work-sponsored men’s group.
Knowing he had to do something, Lynch started pushing hard and fast in the center of the man’s chest. Within a minute, the man gasped for breath.
Just as Lynch leaned over to see if he could help the female passenger, first responders arrived and Lynch backed away, knowing there was nothing more he could do.
“It was just a lot to take in,” said Lynch, a member of the American Heart Association’s 2026 Nation of Lifesavers Class, a small group of volunteers, dedicated to raising awareness of CPR by sharing their own personal stories of survival or rescue. “Mostly I felt an incredible sense of gratitude that I could help someone.”
A strong admirer of the Good Samaritan parable, Lynch is always on the lookout for the opportunity to help others. He learned a lot about himself in that moment and about the importance of learning CPR, along with the confidence that comes from knowing you could be a lifesaver.
“I quickly realized the certification was way less important than the actual CPR training,” he said. “Your ability to help in any capacity is better than doing nothing. If I hadn’t done that training, I probably would not have helped.”
SOURCE:
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News
How healthy is Sodastream?
The SodaStream Sparkling Water Maker is a device that forces carbon dioxide (CO2) gas (stored under pressure in a cylinder) into water, making it sparkling (fizzy)
Sodastream machines have been gaining popularity in recent years as an alternative to store-bought soft drinks. Not only are they more environmentally friendly, but they also offer several health benefits compared to traditional sodas.
Reduced Sugar Intake
One of the most significant health benefits of using a Sodastream machine is reducing sugar intake. Traditional sodas are loaded with sugar, and excessive sugar intake can lead to weight gain, obesity, and other health problems such as Type 2 diabetes. With a Sodastream machine, you can control the amount of sugar you add to your drink, allowing you to enjoy a refreshing beverage without the harmful effects of excessive sugar consumption.
No Artificial Sweeteners
Many store-bought soft drinks contain artificial sweeteners, which can have negative health effects such as headaches and digestive problems. Sodastream machines, on the other hand, allow you to use natural sweeteners such as fruit extracts, honey or agave nectar, giving you a healthier and more natural alternative.
No Preservatives
Another advantage of using a Sodastream machine is that you can avoid preservatives commonly found in store-bought soft drinks. Preservatives such as sodium benzoate and potassium sorbate have been linked to health problems such as cancer and allergies. By making your own drinks, you can avoid these harmful additives and enjoy a healthier, preservative-free beverage.
Eco-Friendly
In addition to the health benefits, using a Sodastream machine is also environmentally friendly. Traditional soft drinks are packaged in plastic bottles or cans, which contribute to environmental pollution. With a Sodastream machine, you can reuse the same bottle multiple times, reducing waste and helping to reduce your carbon footprint.
Variety
Finally, Sodastream machines offer a wide variety of flavors and options, allowing you to customize your drink to your liking. You can mix and match different flavors or create your own unique blends, giving you a healthier and more enjoyable alternative to traditional sodas.
In conclusion, Sodastream machines offer several health benefits compared to traditional store-bought soft drinks. By reducing sugar intake, avoiding artificial sweeteners and preservatives, and being eco-friendly, they offer a healthier and more sustainable alternative to traditional soft drinks. Moreover, with a wide variety of flavors and options, you can customize your drink to your liking, making it a fun and enjoyable way to stay healthy.
