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COPD is usually diagnosed following symptoms and many of the participants with COPD included did not have any symptoms, but they were underdiagnosed

[74] A 2014 review said, "the e-cigarette companies have been rapidly expanding using aggressive marketing messages similar to those used to promote cigarettes in the 1950s and 1960s." [74] In the US, six large e-cigarette businesses spent $59.3 million on promoting e-cigarettes in 2013