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Causes and Risk Factors Most Common Cause: Cigarette smoking (primary) Other Risk Factors: Biomass fuel exposure Air pollution Occupational dust/fumes Recurrent lung infections Aging Genetic Cause: Alpha-1 Antitrypsin deficiency (early-onset emphysema, especially in non-smokers) Pathophysiology (Simplified) Smoking or irritants inflammation elastase and proteases Loss of elastic recoil and destruction of alveolar walls Enlarged airspaces gas exchange surface Air trapping hyperinflation Types of Emphysema (based on lobes affected) 1

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Assuming that other states do not change their cigarette excise taxes,[] and using Michigan's 2006 cigarette sales figures, we would estimate that another 5-cent increase in the cigarette excise tax would result in a drop in legal cigarette sales of 683,500 packs from an increase in casual smuggling alone