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Article History

Received: 15 January 2026

Accepted: 26 February 2026

First Online: 27 March 2026

Declarations

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: Wilhelmine Meeraus, Sudhir Venkatesan and Sabada Dube are employees of, and may hold stock and/or stock options in, AstraZeneca. Lucy Carty is an employee of SRG Recruitment; and was contracted to AstraZeneca for this analysis. Sylvia Taylor is a former employee of AstraZeneca and may hold stock/and or stock options. Ana Goios is an employee of, and holds shares in, P95, which received a consultancy fee for the conduct of the current study from AstraZeneca. Kathryn Evans, Nahila Justo and Yi Lu are employees of Thermo Fisher Scientific, which received funding for the conduct of the current study (data acquisition and analysis) from AstraZeneca. Rachael A. Evans reports receiving funding from AstraZeneca for providing advice during the development of the INFORM study, research grants from National Institute for Health and Care Research, UK Research and Innovation, Wolfson Foundation, and Genentech/Roche to her institution for works not related to current manuscript, non-promotional speaker fees from Boehringer Ingelheim and Moderna, and serving non-paid as European Respiratory Society Group 01.02 Pulmonary Rehabilitation and Chronic Care Chair and American Thoracic Society Pulmonary Rehabilitation Assembly Chair. Jennifer K. Quint reports receiving funding from AstraZeneca for providing advice throughout the current study, research grants from the Medical Research Council, Health Data Research UK, GSK, Boehringer Ingelheim, Asthma + Lung UK, and AstraZeneca to her research institution, and consulting fees from GSK, Evidera, AstraZeneca, and Insmed. Lance Turtle has received consulting fees from Medicines and Healthcare products Regulatory Agency and Bavarian Nordic, and speaker fees from Eisai Ltd., Medscape, and the Primary Care Cardiovascular society. He has received consulting fees from AstraZeneca, Synairgen, and GeoVax, paid to the University of Liverpool and support for conference attendance from AstraZeneca. Lance Turtle is supported by the US Food and Drug Administration Medical Countermeasures Initiative contract 75F40120C00085, and the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections (NIHR207393) at University of Liverpool in partnership the UK Health Security Agency (UKHSA), in collaboration with Liverpool School of Tropical Medicine and University of Oxford. Lance Turtle is based at University of Liverpool. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health, or UKHSA.

: Access to anonymised data was facilitated through the NHS England Secure Data Environment. All analyses were conducted in the secure environment without any personal data transfer. The study protocol was exempted from Ethics Application by the Health Research Authority under the Integrated Research Application System application number 304305. This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments.