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46,47 In non-joint tissues, cigarette smoke has been shown to affect macrophage recruitment, phenotype, phagocytosis, efferocytosis, reactive oxygen species handling, and cytokine signaling, which suggests broad macrophage reprogramming rather than one simple polarization change

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Inflammation & Swelling The immune system responds to the damage by sending inflammatory cells to the lungs, which, over time, causes inflammation and successive narrowing of the airways, causing breathing difficulties