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)
(Feature Impact) Dry eye is one of the most overlooked symptoms of perimenopause, the phase of fluctuating hormones leading up to a woman’s final period, and menopause, the point in a woman’s life when she’s gone a year without a period.
In fact, 79% of women1 recognize hot flashes as a symptom of menopause, but only 14% recognize dry eye as a menopause-related symptom, according to the 2026 Bausch + Lomb (Peri)Menopausal Survey. What’s more, 78% of women1 were surprised to learn that dry eye is a symptom of perimenopause or menopause.
“Dry eye is still widely overlooked as a symptom of menopause, and many women think it’s just a minor nuisance, but the truth is it can significantly affect your daily life,” said Neda Gioia, OD, CNS, IFMCP, FOWNS, founder, Integrative Vision. “Early symptoms are often misunderstood or self-treated but it’s very important for women who experience symptoms to see an eye doctor and get an accurate diagnosis and treatment.”
During perimenopause and menopause, declining hormone levels can impact tear production, tear quality and tear evaporation, contributing to dry eye symptoms including redness, fluctuating vision and a gritty or tired feeling in the eyes, all of which can impact day-to-day comfort and quality of life. If left untreated, dry eyes may worsen over time, potentially impacting eye health and vision. Among peri-, menopausal and post-menopausal women who experienced dry eye, 80% said the symptom came as a surprise.
Respondents reported their dry eye symptoms caused difficulty reading (58%), difficulty using screens (53%), difficulty driving (26%) and reduced productivity (17%), underscoring the often-overlooked impact dry eyes can have on everyday life.1
However, there are a variety of products and treatment approaches available to help manage dry eye symptoms. For example, Bausch + Lomb offers a range of options designed to address the main causes of dry eye.
A doctor-recommended, clinically proven once-daily soft gel supplement that targets the key root causes of dry eyes, Blink NutriTears supports healthy tear production and provides lasting, continuous relief.* § As part of a comprehensive approach to dry eye management, the supplement can be used with Blink Triple Care Preservative Free Lubricant Eye Drops, which are designed to directly address tear evaporation, one of the leading causes of dry eye, and provide instant and long-lasting symptom relief.
An eye care professional can help determine the approach that’s right for each individual. To learn more about dry eye and products to help combat it, visit JustBlink.com.*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
12026 Bausch & Lomb (Peri)Menopause Survey via Suzy, n=402; Women ages 30–80+ who are perimenopausal, menopausal, or post-menopausal
§Based on a clinical study
SOURCE:
Bausch + Lomn
health and wellness
The Oral and Cardiovascular Health Connection: 4 Tips to Protect Your Teeth, Gums and Heart
People often think of dentists and doctors as totally separate healthcare professionals: one cares for your teeth and mouth while the other handles the rest of the body. In reality, the different systems in the human body are closely interconnected and oral health is no exception, making dentists a vital part of your healthcare team. Care for your teeth, gums and heart all at once using these tips.
(Feature Impact) People often think of dentists and doctors as totally separate healthcare professionals: one cares for your teeth and mouth while the other handles the rest of the body. In reality, the different systems in the human body are closely interconnected and oral health is no exception, making dentists a vital part of your healthcare team.
Oral health and heart health have a particularly close connection, with inflammation at the core of it. When your gums are inflamed, the resulting bacteria can make their way from your mouth through your bloodstream, potentially contributing to your blood vessels constricting or becoming blocked. This, in turn, may force your heart to work harder and raise your blood pressure, putting you at risk of heart disease and stroke. More than 46% of adults in the U.S. have high blood pressure, and more than 40% of adults age 30 and older are affected by periodontal (gum) disease.
To help address these issues, the American Heart Association’s Healthy Smiles, Healthy Hearts initiative, in collaboration with Delta Dental of California, is encouraging dental teams to take a total-body perspective with their patients. Simple steps like blood pressure screenings during checkups can give a more complete picture of a person’s overall health. If a member of your dental care team pulls out a blood pressure cuff at your next appointment, it’s a good sign.
“The mouth is a gateway to the body and can often reveal more about your total body health than you may think,” said Daniel Croley, D.M.D., chief dental officer at Delta Dental of California and Affiliates. “Oral health professionals have a powerful opportunity to integrate more into their patients’ collective health care team beyond protecting their patients’ teeth By connecting oral health and heart health, this initiative helps dentists identify risks early and guide patients toward care that can improve and even save lives.”
Care for your teeth, gums and heart all at once using these tips from experts at the American Heart Association.
Follow a Brushing and Flossing Schedule
Good dental health starts with a daily routine. If you don’t want to sheepishly cringe next time the dentist inquires about yours, brush at least twice a day and floss at least once a day to disrupt plaque-forming bacteria. Dentists recommend using toothpaste with fluoride and brushing your teeth and gums thoroughly yet gently, as applying too much pressure can wear away enamel and cause gum recession.
Eat a Healthy Diet and Limit Sugar
Most kids are used to hearing sugar will rot their teeth – and that’s not just a parental scare tactic to get their little hands out of the candy jar. Sugar feeds harmful bacteria in your mouth, producing acid that can cause cavities and gum disease. For a diet your heart and teeth will both appreciate, prioritize vegetables, lean proteins, complex carbohydrates and healthy fats, while limiting added sugars and refined carbohydrates.
Avoid Smoking and Tobacco Products
The connection between smoking and oral disease is well established: smokers face significantly higher risks of developing periodontal disease, losing teeth or being diagnosed with oral cancer. Cigarettes aren’t the only form of tobacco to worry about, either. Vaping, dipping and chewing tobacco can also harm your dental health by drying out your mouth and restricting blood flow to the gums. Since these products are also harmful to heart health, quitting or avoiding them offers plenty of worthwhile benefits. Seek support if you need help to kick the habit.
Communicate with Your Healthcare Team
Since your body’s systems are connected to each other, it’s helpful to talk to your dentist about your blood pressure and to your doctor about your oral health. Start thinking of your dentist as a key member of your integrated healthcare team. Don’t be afraid to share your medical history, discuss the side effects of any medications you’re taking and ask for personalized recommendations on caring for your teeth, gums and overall health.
To learn more about how to improve your oral and cardiovascular health, visit Heart.org/OralHealth.
Photos courtesy of Shutterstock
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5 Habits to Boost Immunity During Cold and Flu Season
(Feature Impact) Your immune system is your strongest ally during cold and flu season, working hard to keep you healthy as you start hearing those telltale coughs and sneezes all around. Help your body do its job well by adopting a few simple habits that naturally support its ability to fight off germs or recover faster.
Talk to your healthcare provider for personalized advice then work on making these habits normal in your household.
Get Regular Exercise
Exercise is like a wonder drug that can improve nearly every aspect of health and wellness. Physical activity increases blood flow, reduces long-term inflammation, helps immune cells circulate through the body to guard against invaders and may even flush bacteria out of your lungs and airways. Plan to fit at least 150 minutes of moderate exercise into each week, like a bike ride, brisk walk, yoga class or on-demand video workout.
Eat Foods That Support Immune Health
To keep your immune system fueled, experts recommend eating a varied diet featuring plenty of fruits, vegetables, nuts, seeds, whole grains and healthy fats like olive oil. Consider adding fresh grapes to your diet to enjoy benefits from their naturally occurring plant compounds.
Protecting the body starts all the way down at the cellular level, and grapes contain powerful polyphenols that support the health and function of cells. Studies indicate certain compounds in grapes, like resveratrol and flavonoids, support immune system function as well as brain, skin, GI and heart health.
These little fruits are easy to add to your diet, whether you enjoy sweet, juicy Grapes from California by the handful or toss them in a blender to make this California Grape Wellness Juice recipe. Support multiple aspects of wellness with the drink’s powerful combination of fruits and vegetables, delivering a variety of immune-boosting vitamins, minerals and antioxidants.
Stay Hydrated
Drinking enough water helps clean your lymphatic system, which is responsible for producing special white blood cells that fight germs. It also keeps membranes in your nose and mouth moist, decreasing infection risk. If you struggle to drink enough, eating water-rich foods like grapes also helps you improve hydration.
Practice Good Germ Hygiene
To increase your odds of staying healthy during peak illness season, hearken back to the tried-and-true hygiene advice your parents might have tried to drill into your head as a kid. Regularly wash your hands with warm water and soap, avoid touching your face while out and about, keep your distance from symptomatic people and disinfect commonly used surfaces like doorknobs when someone in the house or office is sick.
Sleep More, Stress Less
Before you start feeling stressed that you aren’t getting enough sleep, rest assured there are easy changes you can make to support your well-being in both areas. Try switching up your nightly routine to be oriented less around screens and more around calming activities that actually help you wind down, like yoga, meditation or reading.
Discover more health information and recipes at GrapesFromCalifornia.com.
California Grape Wellness Juice
Servings: 3 (1 cup each)
- 5 cups black or red Grapes from California
- 1/2 cup peeled raw beet slices
- 3/4 cup orange juice
- 1/4 cup lemon juice
- 1 small carrot, peeled and sliced
- 1 piece fresh turmeric (1-inch), peeled and sliced or1 teaspoon ground turmeric
- In high-speed blender, puree grapes, beet slices, orange juice, lemon juice, carrot and turmeric until smooth.
- Pour through fine mesh sieve, stirring to extract as much juice as possible, about 3 cups. Stop when mixture starts to get thick. Enjoy immediately or cover and refrigerate until ready to serve.
Notes: This juice can also be added to iced tea or fizzy water.
Nutritional information per serving: 230 calories; 3 g protein; 58 g carbohydrates; 0.5 g fat (2% calories from fat); 0 g saturated fat (0% calories from saturated fat); 0 mg cholesterol; 35 mg sodium; 0 g fiber.
SOURCE:
California Table Grape Commission
