[48,53] Adaptations to chronic smoking, such as down-regulation of -adrenergic receptors, have been used to explain smokers blunted HR response to exercise
The use of pack-years to assess the risk of developing COPD or some other lung diseases has been criticized for being a measure based on the assumption that both smoking intensity and duration are of equal importance.11,16,26 However, some authors argue that it should continue to be used because of its simplicity and because it is a measure that provides information on the cumulative amount of tobacco consumption.9,16,27,28 In this study, COPD risk increases linearly with the increase in pack/years, an aspect that also occurs in the nonparametric model
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