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This is most likely due to the fact that some nicotine is swallowed and therefore undergoes first pass metabolism to cotinine before reaching the systemic circulation (Holm et al., 1992

Below are possible side effects of nicotine addiction: 3 Coronary heart disease Stroke Reduced blood flow to legs and skin Lung cancer Worsened asthma symptoms Chronic obstructive pulmonary disease (COPD) Additional cancers Birth defects Reduced fertility Tooth decay Type 2 diabetes Decreased immune functioning rheumatoid arthritis Nicotine Withdrawal Symptoms Individuals may experience withdrawal symptoms when they attempt to quit or significantly reduce their nicotine intake

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