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This is most common in people who have chronic health problems or weakened immune symptoms, the Mayo Clinic says

Maybe it's because I grew up in NC, tobacco capital of the world, and spent years trying to get my mother to quit (which she finally did), but I really hated that every single lead suddenly turns out to be and have been a smoker for years and we've not known it...and every one of them will still be smoking for a fair amount of time to come, even if it's not shown

The image showed how much tar is built up in an average smokers lungs

McClure Reference Mamede, Ishizu and Ueda2019)

Without insurance, it costs about $100 a month, and $20 a month at his clinic with insurance