Exploring health consequences of Asthma-COPD overlap syndrome in a national study.

Notably, the direct effect of smoking decreased from 0.582 to 0.364 after accounting for mediators, yet remained highly significant (P<0.001), indicating that 62.5% of smoking’s impact operates through pathways not captured by these three mediators—presumably including direct epithelial toxicity, oxidative stress, protease-antiprotease imbalance, and immune dysregulation.

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