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Some people even use both in a combination approach (e.g., patch for background support + pouch for breakthrough cravings), though this should be done under medical supervision

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[266] Human Rights Watch interview with Calvin R., 17, Scott County, Kentucky, September 4, 2013

The transition to a more severe expression of smoking-associated disease is marked by the impaired ability of macrophages to kill bacteria or viruses, the loss of ability to remove dead cells, the degradation and chemical modification of the extracellular matrix, the increasing retention of oligoclonally expanded CD8+ T cells and the induction of interleukin-17-secreting effector T cells