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The massive impact of smoking on mortality is in line with previous studies addressing smoking effects on mortality at the population level

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Smoking is still the primary, causal risk factor leading to COPD, but environmental exposures, such as exposure to biomass fuel combustion, air pollution, and occupational exposures, and poor lung development (both pre- and post-natal) are increasingly recognized as important causes of COPD [3, 12]

Patients Were Younger And More Symptomatic The clinical profile of patients with combined smoking differed meaningfully from that of tobacco-only smokers