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First, tobacco use information was collected only at baseline and did not reflect changes that may have occurred over time

Since norfluoxetine is an active metabolite, such association may impact the response of patients to take fluoxetine as well as implications with increased half-life of this molecule, which is already long, for example, by drug bioaccumulation and the ability to induce serotonin syndromes

Conclusions This large prospective cohort study provided evidence that in utero tobacco exposure, early-life smoking, and environmental pollution were independently and jointly positively associated with an elevated risk for COPD