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The institute say that once a person develops a lung disease, such as COPD, emphysema, or interstitial lung disease, they should not inhale anything other than clean air

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While this variable choice may have been justified at the time of their respective publications given that North Carolina was generally accepted as the predominant source of over-the-road cigarette smuggling, many have noted the greater reliance on sources in other tobacco states such as Virginia and Georgia for such smuggling over recent years

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