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cytotoxic, mutagenic and proinflammatory substances contained in cigarettes Surfactant smoking is associated with reduced surfactant phospholipids fibrotic factors T helper type 1 (Th1) cells are a lineage of CD4 + effector T cell that promotes cell-mediated immune responses and is required for host defense against intracellular viral and bacterial pathogens

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In epithelial cells and fibroblasts, CS induces the expression of the senescence markers p16, p19, and p21 in the development of emphysema [15]

Further research is needed to determine the health effects of highly reactive free radicals from e-cigarettes