Removing the pouch allows nicotine absorption to slow down, which gives the diaphragm a chance to relax
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Wong HL, Murphy SE, Hecht SS (2005) Cytochrome P450 2A-catalyzed metabolic activation of structurally similar carcinogenic nitrosamines: N'-nitrosonornicotine enantiomers, N-nitrosopiperidine, and N-nitrosopyrrolidine