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Quitting smoking is so hard because of the complex interplay between physical addiction to nicotine and the psychological habits formed around tobacco use, as studied in an article by the Centers for Disease Control and Prevention titled Why Quitting Smoking Is Hard. Physically, nicotine creates dependence by altering brain chemistry, leading to withdrawal symptoms such as irritability, cravings, and anxiety when a person tries to quit

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Moreover, the TGF-1/Smad2.3 signalling pathway is strongly implicated in endothelial to mesenchymal transition (EndMT) which plays a key role in the pathogenesis of COPD [129,130,131]

doi:10.1371/journal.pone.0235806 [47] Abou-Dakn M, Schfer-Graf U, Wckel A

The primary reason is that smoking damages the airways and air sacs known as alveoli in the lungs