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This is because COPD is largely associated with frequent and deep inhalation of smokea habit typical of cigarette smoking
Most disturbing, while placebo is the gold standard in most study areas, in smoking cessation studies it's license to steal

Thrasher JF, Abad-Vivero EN, Huang L, O'Connor RJ, Hammond D, Bansal-Travers M, Yong H-H, Borland R, Markovsky B, Hardin J

Policy Change or Abberation

Hallmark gene set analysis reveals pathways associated with interferon-alpha responses and DNA damage repair are downregulated while pathways associated with sterile inflammation are upregulated in NHBECs after DA vapor exposure To further characterize transcriptional profiles, we applied the pre-ranked GSEA to 50 Hallmark gene sets with well-defined biological mechanisms and coherent expression levels

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