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Compared to the never smokers, those with normal spirometry but impaired lung function had worse quality of life scores, more trouble walking and evidence of airway thickening and emphysema on their CT scans

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Cigarette smoke induces COPD-related airway remodeling phenotypes, including airway epithelial hyperplasia, myocyte hyperplasia, squamous metaplasia, EMT, ciliary alterations, loss of secretory cells that produce Scgb1a1, and reduced integrity of the apical junction barrier that controls airway epithelial permeability