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.
Advertisement
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.
Advertisement
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.
Workers who are in frequent contact with potentially sick animals are at high risk of bird flu infection.
Costfoto/NurPhoto via Getty ImagesRon Barrett, Macalester College
Disease forecasts are like weather forecasts: We cannot predict the finer details of a particular outbreak or a particular storm, but we can often identify when these threats are emerging and prepare accordingly.
The viruses that cause avian influenza are potential threats to global health. Recent animal outbreaks from a subtype called H5N1 have been especially troubling to scientists. Although human infections from H5N1 have been relatively rare, there have been a little more than 900 known cases globally since 2003 – nearly 50% of these cases have been fatal – a mortality rate about 20 times higher than that of the 1918 flu pandemic. If the worst of these rare infections ever became common among people, the results could be devastating.
Approaching potential disease threats from an anthropological perspective, my colleagues and I recently published a book called “Emerging Infections: Three Epidemiological Transitions from Prehistory to the Present” to examine the ways human behaviors have shaped the evolution of infectious diseases, beginning with their first major emergence in the Neolithic period and continuing for 10,000 years to the present day.
Viewed from this deep time perspective, it becomes evident that H5N1 is displaying a common pattern of stepwise invasion from animal to human populations. Like many emerging viruses, H5N1 is making incremental evolutionary changes that could allow it to transmit between people. The periods between these evolutionary steps present opportunities to slow this process and possibly avert a global disaster.
Spillover and viral chatter
When a disease-causing pathogen such as a flu virus is already adapted to infect a particular animal species, it may eventually evolve the ability to infect a new species, such as humans, through a process called spillover.
Spillover is a tricky enterprise. To be successful, the pathogen must have the right set of molecular “keys” compatible with the host’s molecular “locks” so it can break in and out of host cells and hijack their replication machinery. Because these locks often vary between species, the pathogen may have to try many different keys before it can infect an entirely new host species. For instance, the keys a virus successfully uses to infect chickens and ducks may not work on cattle and humans. And because new keys can be made only through random mutation, the odds of obtaining all the right ones are very slim.
Given these evolutionary challenges, it is not surprising that pathogens often get stuck partway into the spillover process. A new variant of the pathogen might be transmissible from an animal only to a person who is either more susceptible due to preexisting illness or more likely to be infected because of extended exposure to the pathogen.
Even then, the pathogen might not be able to break out of its human host and transmit to another person. This is the current situation with H5N1. For the past year, there have been many animal outbreaks in a variety of wild and domestic animals, especially among birds and cattle. But there have also been a small number of human cases, most of which have occurred among poultry and dairy workers who worked closely with large numbers of infected animals.
Pathogen transmission can be modeled in three stages. In Stage 1, the pathogen can be transmitted only between nonhuman animals. In stage 2, the pathogen can also be transmitted to humans, but it is not yet adapted for human-to-human transmission. In Stage 3, the pathogen is fully capable of human-to-human transmission.Ron Barrett, CC BY-SA
Epidemiologists call this situation viral chatter: when human infections occur only in small, sporadic outbreaks that appear like the chattering signals of coded radio communications – tiny bursts of unclear information that may add up to a very ominous message. In the case of viral chatter, the message would be a human pandemic.
Sporadic, individual cases of H5N1 among people suggest that human-to-human transmission may likely occur at some point. But even so, no one knows how long or how many steps it would take for this to happen.
Influenza viruses evolve rapidly. This is partly because two or more flu varieties can infect the same host simultaneously, allowing them to reshuffle their genetic material with one another to produce entirely new varieties.
Genetic reshuffling – aka antigenic shift – between a highly pathogenic strain of avian influenza and a strain of human influenza could create a new strain that’s even more infectious among people.Eunsun Yoo/Biomolecules & Therapeutics, CC BY-NC
These reshuffling events are more likely to occur when there is a diverse range of host species. So it is particularly concerning that H5N1 is known to have infected at least 450 different animal species. It may not be long before the viral chatter gives way to larger human epidemics.
Reshaping the trajectory
The good news is that people can take basic measures to slow down the evolution of H5N1 and potentially reduce the lethality of avian influenza should it ever become a common human infection. But governments and businesses will need to act.
People can start by taking better care of food animals. The total weight of the world’s poultry is greater than all wild bird species combined. So it is not surprising that the geography of most H5N1 outbreaks track more closely with large-scale housing and international transfers of live poultry than with the nesting and migration patterns of wild aquatic birds. Reducing these agricultural practices could help curb the evolution and spread of H5N1.
Large-scale commercial transport of domesticated animals is associated with the evolution and spread of new influenza varieties.ben/Flickr, CC BY-SA
People can also take better care of themselves. At the individual level, most people can vaccinate against the common, seasonal influenza viruses that circulate every year. At first glance this practice may not seem connected to the emergence of avian influenza. But in addition to preventing seasonal illness, vaccination against common human varieties of the virus will reduce the odds of it mixing with avian varieties and giving them the traits they need for human-to-human transmission.
At the population level, societies can work together to improve nutrition and sanitation in the world’s poorest populations. History has shown that better nutrition increases overall resistance to new infections, and better sanitation reduces how much and how often people are exposed to new pathogens. And in today’s interconnected world, the disease problems of any society will eventually spread to every society.
For more than 10,000 years, human behaviors have shaped the evolutionary trajectories of infectious diseases. Knowing this, people can reshape these trajectories for the better.Ron Barrett, Professor of Anthropology, Macalester College
This article is republished from The Conversation under a Creative Commons license. Read the original article.
SAN DIEGO, CA, USA /EINPresswire.com/ — Missing teeth can have obvious consequences for your smile, but many people are not aware of how tooth loss affects their oral health, general well-being, and even their facial shape. Once a tooth is detached from the gums, there is no tooth root to stimulate the underlying jawbone; unfortunately, this often causes the bone structure to recede and lose volume. Bone loss can raise a number of aesthetic and functional concerns — particularly when a tooth has been without a replacement for a significant amount of time — including the shifting of surrounding teeth, an increased risk of gum disease, and changes in your jaw structure. In general, greater bone loss is experienced the longer an absent space remains unfilled. While jawbone recession can be debilitating, San Diego cosmetic dentist Landon Libby, DDS discusses potential solutions for bone loss to prevent further damage and regenerate additional bone density.
According to Dr. Libby, implant dentistry can offer a myriad of benefits for individuals with missing teeth, including the ability to maintain bone volume and preserve the full integrity of the jawbone after tooth loss. Using dental implants, implant dentistry aims to replace a missing tooth with an artificial tooth root and a custom-made restoration indistinguishable from a patient’s natural teeth. A titanium post is implanted into the jawbone during treatment, which serves as the “replacement” tooth root. Unlike other tooth replacement options that are not surgically affixed to the underlying bone, dental implants and implant-supported restorations promote new bone regeneration. Not only can this enhance a patient’s oral health and strengthen their jawbone, but implant restorations are also considered to look and feel the most similar to natural teeth. Best of all, implants can be used to replace a single tooth, multiple teeth in a row, or even a full dental arch.
It’s important to understand that every patient may not be a good candidate for dental implants, and bone grafting may be necessary prior to treatment to provide more support for implant placement. As a multi-stage process involving oral surgery, Dr. Libby stresses the importance of selecting an experienced, compassionate, and qualified dental team to place implants and provide a seamless patient experience.
About Landon Libby, DDS Dr. Landon Libby is a Mission Valley-based cosmetic dentist who provides cosmetic, restorative, and family dentistry treatments for patients in and around San Diego. As a DOCS-certified dentist with training in sedation dentistry, Dr. Libby strives to enhance patient comfort during every stage of treatment and redefine what it means to “go to the dentist.” After receiving his Doctor of Dental Surgery (DDS) from the Loma Linda University School of Dentistry, Dr. Libby went into private practice and has been serving the dental needs of the San Diego community for years. Dr. Landon Libby is available for interview upon request.
PUNE, MAHARASHTRA, INDIA /EINPresswire.com/ — Healthcare Education Market Perspective
The Global Healthcare Education Market size was worth USD 103.64 billion in 2022 and is estimated to grow to USD 202.75 billion by 2030, with a compound annual growth rate (CAGR) of approximately 8.75% over the forecast period. The report analyzes the healthcare education market’s drivers, restraints/challenges, and their effect on the demands during the projection period. In addition, the report explores emerging opportunities in the healthcare education market.
Medical professionals watching webinar on online platform. People having virtual class flat vector illustration. Online education, medicine concept for banner, website design or landing web page
Healthcare Education Market Developments
• In 2023, HealthStream (US) purchased Electronic Education Documentation System, LLC (US). This acquisition will broaden Healthstream’s ecosystem by bringing a cutting-edge, cloud-based continuing education management system for healthcare organizations and delivering cutting-edge solutions in the form of Software-as-a-Service (SaaS).
• In 2022, To promote access for surgeons and benefit more patients across the US, GE Healthcare (US) and DePuy Synthes (US) worked together to make GE Healthcare’s OEC 3D Imaging System and DePuy Synthes’ extensive product line more widely available.
Increasing need for skilled healthcare workers to drive market growth
Advertisement
The market for healthcare education is expanding significantly due to the increasing need for skilled healthcare workers. The market for healthcare education is being significantly shaped by the growing demand for qualified healthcare workers. The demand for skilled physicians, nurses, allied health workers, and administrators who can deliver high-quality healthcare services is rising as the world’s population continues to expand and get older. The rising incidence of chronic illnesses and complicated medical disorders that need specialized care has increased this demand. Additionally, the need for healthcare professionals is growing outside conventional clinical responsibilities. The demand for non-clinical positions such as healthcare administrators, informatics experts, and others is also growing. As a result, healthcare education incorporates a variety of academic fields to produce a workforce that is well-rounded and able to meet the many demands of the healthcare sector.
Healthcare Education Market: Regional Landscape
Asia Pacific dominated the Healthcare Education market in 2022
There is a sizable and constantly expanding population in the Asia Pacific region, which generates a sizable demand for healthcare services. The demand for qualified and trained healthcare personnel grows proportionally as healthcare systems enlarge to meet this demand. Additionally, greater investments in healthcare infrastructure, including educational institutions, have been made as a result of the Asia Pacific region’s economic expansion. Governments and commercial organizations are becoming more aware of how crucial a strong healthcare education system is to the development of healthcare services.
Healthcare Education Market Top Players: Stryker (US), SAP (Germany), Adobe (US), Infor (US), Oracle (US), HealthStream (US), Symplr (US), Elsevier (Netherlands), Articulate (US), PeopleFluent (US), Fujifilm Corporation (Japan), GE Healthcare (US), Trivantis Corporation (US), Koninklijke Phillips (Netherlands), Siemens Healthineers (Germany), Coursera (US), and IBM (US).
Healthcare Education Market: Segmentation
The global healthcare education market has been segmented into provider, delivery mode, application, and end-user.
Advertisement
Based on universities, educational platforms, and medical simulation are segments of the global healthcare education market. The university segment to improve the business and department workers, the requirement for continuous learning in a field that is rapidly evolving, partnerships with healthcare organizations, and the emphasis on patient-centered care and interprofessional collaboration are all factors driving the growth of universities and academic institutions in the market for healthcare education solutions. The aforementioned elements help healthcare education programs grow and evolve to satisfy industry demands.
Based on delivery mode, the market is classified into classroom-based, and e-learning. In 2022, the e-learning processing category dominated the global market. Due to a variety of online learning platforms, students have access to educational resources like lectures, videos, quizzes, and other resources in a digital setting. Students can learn at their own pace and convenience in e-learning environments, which usually offer flexibility. Coursera, Blackboard, and Moodle are a few popular e-learning platforms. Because of the COVID-19 pandemic, e-learning platforms have proliferated as a medium of delivery, and this trend is anticipated to continue during the projected period. The overall revenue for Coursera in 2022 was US$523.8 million, a 26% increase over 2021, while the gross profit was US$249.5 million, a 33% increase over 2021.
Based on application, the market is classified into neurology, cardiology, and pediatrics. In 2022, the cardiology category dominated the global market. It is anticipated that factors including the increased prevalence of cardiovascular diseases (CVD), technological improvements, and online courses will raise demand for educational solutions. According to the WHO’s 2021 update, CVDs encompass illnesses like coronary heart disease, cerebrovascular disease, rheumatic heart disease, and others.
Based on end-users, the market is classified into students and physicians. In 2022, the student category dominated the global market. Student prospects have increased as a result of the growing accessibility and availability of healthcare education alternatives, notably online and remote learning options. Students can learn at their own pace, from any location, at any time, and with the help of digital tools and online platforms. This accessibility makes it easier for people from different backgrounds to enter the healthcare industry by allowing students to pursue healthcare education while juggling other responsibilities.
nForming Solutions also provides customization options to tailor the reports as per client requirements. This report can be personalized to cater to your research needs. Feel free to contact our sales team, who will ensure that you get a report per your needs. Thanks for reading this article; you can also get individual chapter-wise sections or region-wise report versions like North America, Europe, or Asia.
Privacy & Cookies: This site uses cookies. By continuing to use this website, you agree to their use.
To find out more, including how to control cookies, see here:
Cookie Policy
Ron Barrett, Professor of Anthropology, Macalester College
This article is republished from The Conversation under a Creative Commons license. Read the original article.
