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Article History

Received: 12 December 2025

Accepted: 13 February 2026

First Online: 21 February 2026

Competing interests

: Alvar Agusti declares research grants to his institution from GlaxoSmithKline, AstraZeneca, Chiesi, and Menarini, consulting fees from GlaxoSmithKline, AstraZeneca, Chiesi, Roche, and Menarini, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from GlaxoSmithKline, AstraZeneca, Chiesi, Roche, Menarini, Zambon, and Glenmark, support for attending meetings and/or travel from Roche, and is the unpaid chairman of the board of directors of GOLD. All are outside the scope of the current manuscript. Aoife Kirk declares unpaid role on the governance board as the co-founder of the Irish Doctors for Environment, the receipt of publishing fees from Elsevier, and that she is the former recipient of consulting fees from Chiesi. All are outside the scope of the current manuscript. Sara Panigone is an employee of Chiesi Farmaceutici SpA. Isabell Crasto De Stefano is an employee of Chiesi Farmaceutici SpA. Mark L Levy has received payments from publishers Taylor and Francis and from Class Publishing for books, consulting fees from Smart Respiratory, Respiri, Imperial College, AstraZeneca, Novartis, and TEVA; speaker/writing fees from Chiesi, AstraZeneca, and TEVA, honoraria for manuscript writing and educational events from Consorzio Futuro in Ricerca, fees for expert testimony from His Majesty’s Coroners (UK), support to attend meetings from TEVA, and has unpaid leadership roles with the Global Initiative on Asthma and NHS England, and is an unpaid advisor for the UK All Party Parliamentary Advisory Group (Asthma, COPD and Allergy). All are outside the scope of the current manuscript. He is also Editor Emeritus of npj Primary Care Respiratory Medicine but had no role in deciding whether the paper should be accepted by the journal for publication.