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)
Child Health
Pediatric Cancer Goes Beyond a Victory Bell: How Research and Innovation Improve Survivorship Rates
(Feature Impact) For every tear-jerking video found online of a child ringing a bell that signifies a cancer journey victory, there are dozens, if not more, people working behind the scenes. From leading minds in cancer research to doctors, nurses and support staff, a vast network of people and decades of medical advancements make those moments possible.
In fact, in the last 10 years, the FDA approved 10 new immunotherapies and 20 molecularly targeted therapies to treat pediatric cancers, according to the American Association for Cancer Research. Those breakthroughs – and the children they impact – come with a cost, which is why Hyundai Hope on Wheels has served as a pioneer in increasing survival rates by investing $303 million in pediatric cancer research over nearly three decades.
Those funds have supported more than 1,600 grants to 210 institutions, leading to new insights into cancer biology, clinical trials and new drug development while bringing hope at all stages of a child’s cancer journey.
However, there remains work to be accomplished. According to a survey conducted by Atomik Research on behalf of Hyundai Hope on Wheels, 46% of U.S. adults believe that a child ringing a hospital bell after cancer treatment signifies the child is cancer-free and their medical journey is largely over. The reality is more nuanced than that. In fact, more than one-third of respondents said they’re not familiar with the term cancer survivorship or they have heard the term but don’t fully understand what it means.
Many health care organizations define survivorship as beginning at the time of diagnosis and continuing through treatment and beyond. According to the American Association for Cancer Research, children who survive cancer face several long-term physical and psycho-social challenges due to their cancer and treatment, including planned surgeries, additional rounds of radiation or other forms of medical treatment to address common physical challenges stemming from chemotherapy.
Survival rates continue increasing with scientific and technological breakthroughs, up from 75% to 85% in nearly three decades, representing roughly 40,000 more children surviving their diagnoses. More than 3 in 4 U.S. adults are encouraged by that progress.
For survivors, treatment is just the beginning. Research, follow-up care and long-term funding determine what comes next, and every grant funded and every survivorship program backed means more children reaching adulthood.
According to the survey, more than 80% of adults said they’re more likely to support organizations that fund survivorship services, creating opportunities to fund crucial research and support for children facing pediatric cancer. Collaboration among leading minds, made possible by funding from organizations like Hyundai Hope on Wheels, has led to the development of comprehensive approaches to help children thrive during life after cancer, including enhanced medical records, AI integration, socioemotional support and combatting long-term side effects.
Find more information and ways you can join the fight by visiting HyundaiHopeOnWheels.org.
Photo courtesy of Shutterstock
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Child Health
A child rings the cancer bell. Here’s what that moment doesn’t show
Cancer Bell: A child who’s been treated for cancer walks down the hall of a medical facility, nurses and doctors smiling at them from all corners of the room. The child rings a bell, and everyone cheers as the kid hugs their loved ones. These heartfelt videos appear regularly across social media. What helps make each of those moments possible is decades of research and innovation. For every bell-ringing child whose video goes viral online, a longer health journey awaits.
A child rings the cancer bell. Here’s what that moment doesn’t show
(Sheeka Sanahon) A child who’s been treated for cancer walks down the hall of a medical facility, nurses and doctors smiling at them from all corners of the room. The child rings a bell, and everyone cheers as the kid hugs their loved ones. These heartfelt videos appear regularly across social media. What helps make each of those moments possible is decades of research and innovation. In the last 10 years, the Food and Drug Administration (FDA) approved 10 new immunotherapies and 20 molecularly targeted therapies to treat pediatric cancers, according to the American Association for Cancer Research.
For every bell-ringing child whose video goes viral online, a longer health journey awaits. Hyundai Hope on Wheels, which has funded pediatric cancer research for nearly three decades, commissioned a survey to understand how much Americans know about that journey.
As September marks Childhood Cancer Awareness Month, what that journey actually looks like is worth understanding. According to the survey, 46% of U.S. adults believe that a child ringing a hospital bell after cancer treatment signifies the child is cancer-free and their medical journey is largely over. The reality is more nuanced than that.
When cancer survivorship begins
Many health care organizations define survivorship as beginning at the time of diagnosis and continuing through treatment and beyond. Understanding survivorship this way helps recognize that a child’s cancer journey is about more than reaching the end of treatment. It also includes managing long-term physical, emotional and medical needs that may continue for years to come.
More than a third of U.S. adults say they’re not familiar with the term cancer survivorship or they have heard theterm but don’t fully understand what it means.
According to the American Association for Cancer Research, children who survive cancer face several long-term physical and psycho-social challenges due to their cancer and treatment. Children could face planned surgeries, additional rounds of radiation, or other forms of medical treatment to address common physical challenges stemming from chemotherapy. Every child’s medical treatment plan is different based on their specific needs, but one thing is clear: Pediatric cancer survivors need ongoing support as they navigate long-term health challenges.
Supporting children to live long, full lives
More than 3 in 4 U.S. adults are encouraged by the progress in pediatric cancer, up 5 points from last year. There’s good reason to be hopeful, too. According to the American Cancer Society, the survival rate among pediatric cancer patients has increased from 75% to 85% in nearly three decades, representing 40,000 more children surviving their cancer diagnosis.
Survival rates continue to increase thanks to breakthrough science and technology, and higher standards of care. Pediatric cancer research has led to new insights into cancer biology, clinical trials, and new drug development.
More than 8 in 10 adults say they’re more likely to support organizations that fund survivorship services, which creates more opportunities to fund crucial research and support for children facing pediatric cancer.
Methodology
Hyundai Hope on Wheels commissioned Atomik Research to conduct an online survey of 1,005 adults throughout the United States. The margin of error is +/- 3 percentage points with a confidence level of 95%. Fieldwork took place March 19-26, 2026. Atomik Research, part of 4media group, is a creative market research agency.
Photo courtesy of Shutterstock
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Family
The back-to-school haircut is more than hair: Survey finds 94% of parents say their son’s appearance affects their confidence
(Sheeka Sanahon) Parents spend years styling their children, picking out just the right outfits for special occasions, choosing a haircut that suits their sweet little faces, and doing their best to keep up with how quickly they outgrow their shoes. Just as parents begin to master all the moving parts, a new variable gets thrown into the equation: the opinions of the child whose every style decision they once made.
According to survey data from Sport Clips Haircuts, a sports-themed haircutting franchise specializing in haircuts for men and boys, 84% of parents say that by the time their son reaches middle or high school, he cares significantly or somewhat more about his appearance. According to Psychology Today, physical appearance is important for adolescent children as a means to express identity and to fit in with the norms of their peers. What has changed is the amount of pressure on today’s generation of children to present themselves well; 71% of parents surveyed by Sport Clips say boys today face more pressure to look put together going into a new school year than they remember from their own school years.
Preteen and Teen Boys are Developing Their Own Sense of Style
The surveyed parents report that in the coming days and weeks before the new school year begins, more than a third of their preteen and teen boys ask for a back-to-school haircut. Another 22% of parents say both they and their boys bring it up around the same time. That’s more than half of boys already thinking about how they’ll show up on the first day.
If you thought mom and dad’s opinions mattered regarding the type of haircut they want, think again. More than half of boys ages 11 to 17 know exactly what haircut they want to get before the school year begins. Parents report that many of them are inspired by celebrities, athletes or people they follow online.
The Confidence Connection
As children get older and express more desire for choosing their style, giving them the choice to pick what’s right for them can be a great opportunity to boost their confidence. Ninety-five percent of parents say there is a connection between how confident their son feels about his appearance and how he shows up at school, in sports and social activities. Young boys and their parents are thinking about more than just the haircut. Finding clothes that their son feels good in, as well as talking through what he’s most excited and most nervous about for the new school year, are all part of the preparation.
The Back-to-School Checklist
This checklist creates an important set of traditions to get the school year started off on the right foot. While 71% of parents say getting their son a fresh haircut or new hairstyle has become a reliable part of their back-to-school routine, 20% notice their child shift back into school mode when they pick out their first day outfit. For 19%, it’s when he packs or organizes his bag.
The Styles Middle School and High School Boys Are Asking For
So what styles are boys most likely to ask for to start this school year? According to the survey data, 30% of boys want a tapered fade like the haircut U.S. goalkeeper Matt Freese wore during the 2026 World Cup. Nearly a quarter (24%) of respondents said their child wants a classic cut, like the kind of style YouTuber Caylus Cunningham tends to wear. Only 10% of boys are requesting a longer or shaggy style, like actor Jacob Elordi, and even fewer are looking for fringe bangs, the broccoli cut (which is short on the sides and curly on top) or a buzz cut.
A few parents aren’t sure what kind of look their child is going for this school year. Eight percent say they’re not even sure what to call the hairstyle preferred by the boys in their lives.
Methodology: Sport Clips Haircuts commissioned Atomik Research to conduct an online survey of 1,000 adults throughout the United States. The sample consists of U.S. parents of boys aged 11 to 17. The margin of error is +/- 3 percentage points with a confidence level of 95 percent. Fieldwork took place between July 9 and July 15, 2026. Atomik Research, part of 4media group, is a creative market research agency.
Photo courtesy of Shutterstock (children on school bus)
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