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Clinical, behavioural, and functional parameters were compared between study cohorts and included: (1) respiratory symptoms, (2) smoking status (biochemically confirmed by exhaled breath carbon monoxideeCO), cigarette consumption per day (cig/day), as well as HTP use, (3) the annual number of severe COPD exacerbations, (4) post-bronchodilator lung function parameters (forced expiratory flow in 1 sFEV1

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Heavy smokers (more than 20 cigarettes daily) often start with higher usage rates

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