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For people with genetic variants that cause more of an impact on CYP1B1 upregulation combined with an inability to eliminate the estrogen metabolites fast enough (due to phase II genes, diet, and lifestyle) then cigarette smoking is going to significantly increase the bad estrogen metabolites

On the basis of the results available up to date, the Global Initiative for Chronic Obstructive Lung Disease [119] recognizes that mucolytic and antioxidant drugs, such as NAC, can be used as an adjunct therapy to reduce the risk of acute exacerbation of COPD, but in a limited way due to the lack of robust randomized controlled clinical trials (level of evidence B)

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