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These differences in the manufacturing process (e.g., the fermentation process) typically result in higher nitrate levels in the tobacco and a higher (alkaline) pH of cigar smoke than cigarette smoke, which has important implications for nicotine absorption orally and by inhaling

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Underlying mechanisms may include chronic airway inflammation, impaired mucociliary clearance, increased bronchial hyperresponsiveness, increased development of T helper cell 2 (Th2) pathways relative to Th1 pathways, increased production of IgE, and greater allergic sensitization [9,25]