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Emphysema of the peri-bronchial lung parenchyma can occur more than 10 years after small airway obstruction can be detected, and predominantly in the areas initially affected by air trapping

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This could be attributed to the fact that the average user consumes can per day or 8-12 nicotine pouches

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However, if the goal of the tobacco surcharge is to tax or penalize a member of the health plan for choosing to use tobacco, a tobacco surcharge will successfully meet that goal but then the strategy would better fit as a health plan management or benefit contribution strategy