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A key element of the study was the validation of the Italian version of the Respiratory Symptom Experience Scale (IT-RSES), a sensitive clinical tool designed to detect early signs of respiratory distress in smokers

Funding: The authors are grateful to the Deanship of Scientific Research, King Saud University, for funding through the Vice Deanship of Scientific Research for Research Chairs

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However, urinary cotinine concentrations require creatinine based adjustment for renal clearance of cotinine because urinary cotinine concentrations can be affected by several factors, including urine pH, renal function, and urine flow rate