July 23, 2024

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A Puzzling No Name Lung Disease Affecting Millions of Smokers

A Puzzling No Name Lung Disease Affecting Millions of Smokers


A Puzzling No Name Lung Disease Affecting Millions of Smokers.

Millions of Americans with tobacco-related lung disease exhibit symptoms that don’t meet any existing tobacco-related disease criteria, including chronic obstructive pulmonary disease, the most common form of disease, according to a new study led by researchers at UCSF. lung disease (COPD).

The study, recently published in the Journal of the American Medical Association (JAMA), found that half of the participants with heavy tobacco exposure showed persistent high levels of respiratory symptoms.


These symptoms include shortness of breath, daily cough and production of phlegm, and decreased ability to exercise. Interestingly, these individuals performed satisfactorily on a breathing test commonly used to diagnose COPD.


A Puzzling No Name Lung Disease Affecting Millions of Smokers


COPD assessment was an important component of the COPD Subpopulation and Interim Outcome Measures Study (SPIROMICS), a multicenter study of 1379 participants aged 40 to 80 with more than 20 pack-years of tobacco exposure (smoking a pack of cigarettes a day for 20 years or more) were assessed.

The study also included a control group of participants who had never smoked and had no airflow obstruction.


Chronic obstructive pulmonary disease is the sixth leading cause of death in the United States and is often linked to long-term smoking.

According to the Centers for Disease Control and Prevention, an estimated 12.5 million Americans will be diagnosed with COPD in 2020.

However, previous research has shown evidence of impaired lung function in more than 18 million people, suggesting that millions more may be suffering without a definitive diagnosis.


COPD is assessed by spirometry, a lung function test that measures how quickly and efficiently a person’s lungs inflate and deflate under maximum effort.

COPD is diagnosed if tests show airflow obstruction, indicating that not enough air can be expelled within a normal time frame.

Evidence of airflow obstruction is medically defined as an abnormally low ratio of forced expiratory volume in one second (FEV1) to total forced vital capacity (FVC) during expiration.


“We found that many primary tobacco contacts had the same symptoms as COPD patients but were not diagnosed with COPD because their FEV1/FVC ratio was considered normal on spirometry,” said the study’s first author, Dr. William McKleroy, a former UCSF pulmonology researcher. “This shows that there are still large gaps in providing effective and considerate care for people exposed to tobacco, highlighting the need for further research to find ways to help them.”


Participants participated in SPIROMICS I from November 2010 to July 2015 and were followed until July 2021 in the extension study SPIROMICS II.

Each year for three to four years, they underwent spirometry, a 6-minute walk test, an assessment of respiratory symptoms, and a CT scan of their lungs.

Many of these participants completed another round of testing five to 10 years after their initial visit.


Some study participants were found to have COPD after undergoing spirometry, while others had spirometry results that were “retained,” meaning they did not have COPD.

The researchers found that the vast majority of participants with tobacco exposure and preserved vital capacity (TEPS) and lung symptoms at the start of the study remained symptomatic at more than five years of follow-up.

They also had high rates of exacerbation of respiratory symptoms and shortness of breath during the study, which limited their mobility.


In addition, there was no increase in the incidence of COPD in symptomatic TEPS participants compared with asymptomatic TEPS participants (33.0% in symptomatic TEPS participants vs.

Incidence rate was 31.6%), and the rate of decline in lung function (measured as the rate of decline in FEV1 over time) was not accelerated in symptomatic TEPS participants compared with asymptomatic TEPS participants.

In contrast, participants with COPD did experience a faster decline in FEV1 compared to asymptomatic TEPS participants.


“These findings suggest that a substantial proportion of tobacco smoke-exposed individuals without airflow obstruction have persistent, asymptomatic non-obstructive chronic airway disease, which is distinct from COPD. Although current COPD guidelines classify tobacco-exposed individuals with preserved lung capacity as pre-COPD, data from this study highlight the need to broaden the definition of smoking-related lung disease in order to develop new treatments.”


Dr. James Kiley, director of the Division of Pulmonary Diseases at the National Heart, Lung, and Blood Institute at the National Institutes of Health, added that the study found that many smokers People with the history of the disease have respiratory symptoms and are at risk of exacerbation for years.


“Even in people with no respiratory symptoms and normal breath tests, smoking continues to harm their lungs,” Kelly said. The findings highlight the importance of quitting smoking and the need for regular follow-up of both symptomatic and asymptomatic smokers sex, and calls for more research to treat smoking-induced respiratory symptoms.”


In addition to the findings related to symptomatic TEPS, the study also found that blacks in the study had a higher proportion of symptomatic TEPS compared with white participants.

They also found that black participants in the study had a higher risk of developing COPD compared with white participants.

The authors recommend an assessment of the impact of occupational and environmental exposures, socioeconomic status, and structural racism on the development of these symptoms.





A Puzzling No Name Lung Disease Affecting Millions of Smokers

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