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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(Feature Impact) Whether you’re enjoying a leisurely weekend morning with the family or savoring those last few moments before rushing out the door, a filling, healthy breakfast is a perfect way to begin the day. Easy recipes that take less than 30 minutes (and can even be prepared the night before) make busy mornings a breeze.
Sheet Pan Pancakes are simple to whip up any day of the week – no flipping required – while Healthy Sausage Breakfast Muffins let you put protein on the menu in a kid-friendly package. When shopping for these delicious breakfasts, look for the Healthy Family Project and Produce for Kids logos to choose healthier foods and make a difference locally.
“Breakfast doesn’t have to be complicated to be powerful – a quick, balanced meal can help kids stay full, focused and energized for the day ahead,” said Tony Castillo, contributing registered dietitian at Healthy Family Project. “For growing kids, a protein-rich breakfast can help support energy, satiety and the building blocks they need as they develop. The best breakfast is one that’s simple, satisfying and realistic for busy mornings because consistency matters more than perfection.”
The versatility of these pancakes allows for endless customization and experimentation with different toppings, from fresh fruit and nuts to savory options like cheese and spinach, making them an ideal fit for the whole family. They also freeze well, so you can pop them in the toaster to have breakfast ready in a flash when hectic schedules interfere with your morning routine.
For another on-the-go solution, these breakfast muffins are made with just five ingredients, including protein pancake mix to help fuel the day. The savory combination of turkey sausage and cheddar cheese is complemented by the sweetness of onion, giving them the flavor your family desires.
To find more ways to put a nutritious breakfast on the family table, visit HealthyFamilyProject.com.
Sheet Pan Pancakes
Recipe courtesy of the Healthy Family Project
Prep time: 10 minutes
Cook time: 5 minutes
Servings: 6
- Nonstick cooking spray
- 1 1/2 cups all-purpose flour
- 3 1/2 teaspoons baking powder
- 1 tablespoon sugar
- 1 teaspoon salt
- 1 1/4 cups milk
- 1 large egg
- 2 tablespoons unsalted butter, melted
- 1/2 cup sliced strawberries
- 1/4 cup blueberries
- 1/4 cup mini chocolate chips
- Preheat oven to 425 F. Cover baking sheet with parchment paper and spray with nonstick cooking spray. Set aside.
- In large bowl, mix flour, baking powder, sugar and salt. Add milk, egg and melted butter; mix until smooth.
- Pour batter onto prepared baking sheet and smooth into even layer that covers pan. Top with strawberries, blueberries and chocolate chips.
- Bake 5-7 minutes, or until cooked and golden brown. Let cool slightly before cutting into squares.
Healthy Sausage Breakfast Muffins
Recipe courtesy of the Healthy Family Project
Prep time: 3 minutes
Cook time: 23 minutes
Servings: 12
- Nonstick cooking spray
- 1 onion, diced
- 1 pound turkey sausage
- 4 eggs
- 1/2 cup shredded cheddar cheese
- 1 cup protein pancake mix
- Preheat oven to 350 F.
- Spray 12-cup muffin pan with nonstick cooking spray; set aside.
- Spray large skillet with nonstick cooking spray.
- In prepared skillet over medium heat, cook onion until translucent. Add turkey sausage and cook until no longer pink. Remove from heat.
- In large mixing bowl, lightly beat eggs. Add shredded cheese, pancake mix and sausage and onion mixture; mix well.
- Fill prepared muffin cups about 3/4 full with mixture.
- Bake 18-20 minutes, or until golden brown on top.
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At our core, we at STM Daily News, strive to keep you informed and inspired with the freshest content on all things food and beverage. From mouthwatering recipes to intriguing articles, we’re here to satisfy your appetite for culinary knowledge.
Visit our Food & Drink section to get the latest on Foodie News and recipes, offering a delightful blend of culinary inspiration and gastronomic trends to elevate your dining experience. https://stmdailynews.com/food-and-drink/
Last Updated on May 13, 2026 by Daily News Staff
A Healthier, Greener Home: Eco-Friendly Cleaning Hacks
(Feature Impact) Keeping your home clean doesn’t have to mean filling your cabinets with harsh chemicals or single-use cleaning products. In fact, some of the most effective solutions may already be in your pantry.
By swapping a few everyday products for simple, eco-friendly solutions, you can clean effectively, save money and make your home a little greener. If you’re looking to reduce waste, cut back on toxins and simplify your cleaning routine, natural ingredients like vinegar, baking soda and lemon can deliver results while also being safer for your home – and the environment.
Make Your Own All-Purpose Cleaner
Instead of buying multiple cleaners for different surfaces, try a DIY solution that works in many areas of the home. In a spray bottle, combine 1 cup white vinegar, 1 cup water and 10 drops of the essential oil of your choice – such as lemon, lavender or tea tree – then use it on countertops, sinks, glass and other surfaces to curb grease and grime. Avoid using vinegar-based cleaners on natural stone like granite or marble, however, as its acidity can cause damage.
Let Baking Soda Do the Scrubbing
One of the most versatile eco-friendly cleaners around, baking soda acts as a gentle abrasive that helps lift stains without scratching surfaces. Simply sprinkle baking soda onto sinks, bathtubs, cookware, stovetops or tile grout then scrub with a damp sponge or cloth for a sparkling clean finish.
Freshen Carpets Naturally
Carpets and rugs can trap odors, but a DIY deodorizer made of 1 cup baking soda and 10-15 drops of the essential oil of your choice can replace chemical sprays and keep floor surfaces smelling fresh. Just sprinkle across the carpet, let sit for 15-20 minutes then vacuum.
Use Lemon to Cut Grease and Stains
Lemon juice is a powerful natural cleaner due to its acidity and antibacterial properties. It can leave behind a fresh scent when used to clean cutting boards, remove soap scum and water spots or deodorize garbage disposals. For stubborn grime, mix lemon juice with baking soda to create a paste that can tackle tough surface stains.
Naturally Deodorize Drains
If your kitchen sink smells unpleasant, skip the harsh chemical drain cleaners. Pour 1/2 cup baking soda down the drain then add 1/2 cup white vinegar. Let the mixture fizz a few minutes then flush with hot water to help loosen buildup while neutralizing odors.
Polish Stainless Steel with Pantry Staples
Remove grimy fingerprints and give stainless steel appliances a streak-free shine with a simple mixture of 1 tablespoon white vinegar and 1 tablespoon olive oil.
Find more DIY, eco-friendly cleaning tips and tricks at eLivingtoday.com.
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.
Food and Beverage
Balance Your Plate with Produce, Protein and Whole Grains
Making health-conscious decisions with your at-home menu doesn’t have to be complicated, but it does require commitment and a little more foresight at the grocery store. Simple adjustments to overall eating patterns, like building your plate around produce, powerful proteins and whole grains, can encourage better health.
(Feature Impact) Making health-conscious decisions with your at-home menu doesn’t have to be complicated, but it does require commitment and a little more foresight at the grocery store. Simple adjustments to overall eating patterns, like building your plate around produce, powerful proteins and whole grains, can encourage better health.
Nutritious meal-planning can be easy, affordable and delicious – and it all starts with a little balance. Consider this advice from the American Heart Association’s Healthy for Good initiative, nationally sponsored by the Egg Nutrition Center, to adequately round out a healthy plate.
Fill Half Your Plate with Fruits and Veggies
Loaded with nutrients, fresh produce is a perfect place to start each plate. Fill about half your plate with combinations of bananas, strawberries, blueberries, sweet potatoes, peas, carrots and more of your favorites. To boost variety with each meal, look for fruit and veggie blends or step out of your usual routine and try something new.
Grocery tip: Frozen fruits and veggies are often cheaper and just as delicious as their fresh counterparts. It’s frozen right after it’s picked, locking in freshness for a longer shelf life. Just be sure to avoid products with added salt or sugar.
Carve Out a Quarter of the Plate for Powerful Proteins
Healthy food isn’t just fuel. It should be easy and nourish you, too. Look for versatile solutions that provide a protein power-up like skinless chicken breast, no-salt-added beans, low-sodium tuna, tofu or eggs.
High-quality protein from foods, along with a balanced diet and regular exercise, can help support the muscles in your body. Eggs are an example, along with lean animal protein and some plant-based proteins. According to the American Heart Association’s guidelines, healthy people can include up to one whole egg daily, and up to seven per week, as part of a heart-healthy diet. For older adults with normal cholesterol, two eggs per day is acceptable.
Eggs deliver both protein and choline, nutrients that help support growing brains and bodies, especially early in life. In fact, many Americans don’t get enough choline, a critical nutrient for supporting brain development, memory and mood.
Grocery tip: Stock up on proteins that offer both versatility and affordability, helping you cook multiple meals per week without putting a dent in your wallet. Eggs are a perfect example as they can be used at any meal, not just breakfast – try them in wraps or omelets in the morning, hard-boil them to go with a lunchtime salad or add to a frittata at dinner.
Save a Corner for Whole Grains
Finally, fill that last quarter of the plate with ready-to-go whole grains, many of which provide dietary fiber that can support a healthy heart and healthy digestion. Conversely, most refined grains contain little or no fiber.
Examples of whole grains include barley, brown rice, corn, oatmeal, rolled or steel-cut oats, popcorn, quinoa, sorghum and wild rice, along with products labeled “whole grain” or “whole wheat” like bread or pasta.
Grocery tip: Look for whole grains that can make mealtime a cinch. Corn tortillas, instant oats and even popcorn can help you create nutritious plates and better-for-you snacks with the snap of your fingers. Try keeping packets of pre-cooked brown rice on hand to bulk up favorite dishes or toss with leftovers to round out a healthy plate.
Visit Heart.org to discover more nutrition guidance for heart-healthy meals.
3 Tips to Complement a Healthy, Balanced Plate
Nutrition isn’t just about what’s on your plate – it’s also about what’s next to it and how much is on it. Pair a balanced meal with this advice to help take healthy eating to the next level.
Stay Hydrated
If it’s not already a habit, add a glass of water to each meal. Staying hydrated helps your heart pump blood throughout the body, get rid of waste and regulate body temperature. While water is the best source of hydration, water-rich foods like fruits and vegetables can also play a role.
Watch Portion Sizes
Pay attention to suggested servings from your favorite food groups. For example, one slice of whole-grain bread, 1/2 cup of cooked pasta and two ounces of cheese (about the size of a domino) are the suggested serving sizes for these popular foods.
You can serve and eat smaller portions by:
- When cooking at home, offer the proper serving size to each family member then put extra food away for leftovers.
- When dining out, skip appetizers and split your meal with a friend or partner.
- Avoid eating while watching TV or at your computer. It may be harder to control how much you’re eating if you’re not paying full attention.
- Mindfully measure out your snacks – even fruits and veggies – into appropriate portions before serving instead of helping yourself directly from the bag or box.
Limit Salt
While sodium supports vital functions like controlling your body’s fluid balance, excess sodium in your bloodstream pulls water into the blood vessels, increasing the amount of blood inside them and thus increasing blood pressure. More than 70% of the sodium people eat comes from packaged, prepared and restaurant foods due to salt added for flavoring, stabilizing, preserving and reducing bacterial risk, according to the American Heart Association.
Cutting back on sodium can help reduce the rise in blood pressure that occurs as you age, even if you don’t have high blood pressure now. It may also help reduce the risk of heart attack, heart failure, kidney disease and more.
Try cooking more meals at home where you can control sodium intake, flavoring foods with herbs and spices instead of table salt and rinsing canned beans and vegetables to wash away excess sodium.
Photo courtesy of Shutterstock (family preparing meal)
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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.
