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This is because COPD is largely associated with frequent and deep inhalation of smokea habit typical of cigarette smoking

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Additionally, mirtazapine is a strong antagonist at specific serotonin receptors (5-HT2 and 5-HT3) which blocks these receptors and channels serotonin signaling through a different serotonin receptor (5-HT1) which is thought to mediate antidepressant effects while minimizing the other typical serotonergic side effects seen with SSRIs and SNRIs such as sexual dysfunction and gastrointestinal symptoms