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Other processes involved with lung damage include oxidative stress produced by high concentrations of free radicals in tobacco smoke and released by inflammatory cells and breakdown of the connective tissue of the lungs by proteases (particularly elastase) that are insufficiently inhibited by protease inhibitors

On the other hand, substance use, including nicotine exposure, may cause damage to the brain and accelerate brain aging potentially through its neurotoxic properties, indirectly exacerbated by excessive smoking 8,10

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