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Article History

Received: 10 April 2025

Accepted: 11 August 2025

First Online: 17 September 2025

Declarations

:

: The study protocol was approved by the central ethical committee in Marburg (Ethikkommission FB Medizin Marburg, approval number 200/09) and the respective local ethical committees: Bad Reichenhall (Ethikkommission Bayerische Landesärztekammer); Berlin (Ethikkommission Ärztekammer Berlin); Bochum (Ethikkommission Medizinische Fakultät der RUB); Borstel (Ethikkommission Universität Lübeck); Coswig (Ethikkommission TU Dresden); Donaustauf (Ethikkommission Universitätsklinikum Regensburg); Essen (Ethikkommission Medizinische Fakultät Duisburg-Essen); Gießen (Ethikkommission Fachbereich Medizin); Greifswald (Ethikkommission Universitätsmedizin Greifswald); Großhansdorf (Ethikkommission Ärztekammer Schleswig–Holstein); Hamburg (Ethikkommission Ärztekammer Hamburg); MHH Hannover/Coppenbrügge (MHH Ethikkommission); Heidelberg Thorax/Uniklinik (Ethikkommission Universität Heidelberg); Homburg (Ethikkommission Saarbrücken); Immenhausen (Ethikkommission Landesärztekammer Hessen); Kiel (Ethikkommission Christian-Albrechts-Universität zu Kiel); Leipzig (Ethikkommission Universität Leipzig); Löwenstein (Ethikkommission Landesärztekammer Baden-Württemberg); Mainz (Ethikkommission Landesärztekammer Rheinland-Pfalz); München LMU/Gauting (Ethikkommission Klinikum Universität München); Nürnberg (Ethikkommission Friedrich-Alexander-Universität Erlangen Nürnberg); Rostock (Ethikkommission Universität Rostock); Berchtesgadener Land (Ethikkommission Land Salzburg); Schmallenberg (Ethikkommission Ärztekammer Westfalen-Lippe); Solingen (Ethikkommission Universität Witten-Herdecke); Ulm (Ethikkommission Universität Ulm); Würzburg (Ethikkommission Universität Würzburg). The study was performed in accordance with the declaration of Helsinki, and all patients provided written informed consent prior to study inclusion.

: Not applicable.

: Martin Eichenlaub, Heiko Lehrmann, Frank Biertz, Amir S. Jadidi, Klaus Kaier, Henrik Watz, Benjamin Waschki and Thomas Arentz have no competing interests. Björn C. Frye received lecture and advisory fees from Advita Lifescience GmbH, Astra Zeneca, Boehringer Ingelheim and Vifor outside the submitted work. Björn C. Frye received research grants from Advita Lifescience GmbH and BMS outside the submitted work. Björn C. Frye is supported by the Berta-Ottenstein-Program for Advanced Clinician Scientists from the Faculty of Medicine, University of Freiburg. Thomas Melzer is co-founder and scientific consultant of the deep tech startup AICU GmbH, Heilbronn. The present results are not related to the company's activities. He continued to receive travel allowances and speaking fees from AstraZeneca outside the submitted work. He is currently a Fellow of the Collège des Ingénieurs, Munich. Peter Alter received unrestricted grants from GSK, Chiesi, AstraZeneca and Sanofi, consulting fees (advisory board) from Sanofi, honoraria for presentation from StreamedUp GmbH and travel support from Sanofi and Boehringer Ingelheim outside the submitted work. Barbara Christine Weckler performed unpaid contract work for AstraZeneca outside the submitted work. She is Chair of the Scientific Advisory Board of the German Lung Foundation and her research is supported by the German Federal Ministry of Education and Research (BMBF). Franziska C. Trudzinski received an innovation fund (funding code: 01NVF19023) of the Federal Joint Committee (G-BA) according to §92(1) Social Code Book V and personal fees from Boehringer Ingelheim, Chiesi, GSK, Grifols, Novartis, CSL Behring, Streamed up, RG Gesellschaft für Information und Organisation mbH, Knorr Stiftung, AstraZeneca and Apontis Pharma outside the submitted work. Advisory board: CSL Behring, GSK outside the submitted work. Julia D. Michels-Zetsche reports a relationship with the Federal Joint Committee of Doctors Hospitals and Health Insurers that includes: funding grants for the PRiVENT project as well as payment or honoraria for lectures from AstraZeneca and reimbursement of travel expenses from CSL Behring outside the submitted work. Frederik Trinkmann reports grants from AstraZeneca, Bayer, Boehringer Ingelheim, Chiesi, Novartis, Roche, BMBF, DZL, Markedsmodningsfonden and E + H Knorr Stiftung, as well as consulting fees and honoraria from AstraZeneca, Berlin Chemie, Boehringer Ingelheim, BMS, Chiesi, Fisher & Paykel, GSK, Janssen-Cilag, Merck Healthcare, Novartis, Omron, OM-Pharma, Roche, Sanofi, Aventis and Thorasys, and travel support from AstraZeneca, Actelion, Bayer, Berlin Chemie, Boehringer Ingelheim, Chiesi, Mundipharma, Novartis, Pfizer and TEVA outside the submitted work. Felix J. F. Herth received fees for lectures from CSL Behring, Grifols, AstraZeneca, BerlinChemie, GSK and Chiesi outside the submitted work. Felix J. F. Herth´s research is supported by the German Federal Ministry of Education and Research (BMBF). Hans-Ulrich Kauczor received fees for lectures and grant support to the institution from Siemens, Philips, and Boehringer Ingelheim outside the submitted work. Hans-Ulrich Kauczor serves on advisory boards of Median and Contextflow outside the submitted work. His research is supported by German Federal Ministry of Education and Research (BMBF) and by the European Commission (EU4Health). Kathrin Kahnert reports personal fees from Astra Zeneca, Berlin Chemie, Insmed, Chiesi, Santis, Boehringer Ingelheim outside the submitted work. Rudolf A. Jörres received fees for lectures from Chiesi, AstraZeneca and GSK outside the submitted work. Robert Bals received grants from Sander Stiftung, Schwiete Stiftung, DFG, BMBF, Krebshilfe, State of Saarland outside the submitted work. Advisory board, consulting fees and travel support: AstraZeneca, CSL, Novartis, Regeneron, Grifols outside the submitted work. He is one of the Editors in Chief of Respiratory Research. Dirk Westermann received honorary from Abiomed, AstraZeneca, Edwards, Meril, Novartis outside the submitted work. Claus F. Vogelmeier gave presentations at symposia and/or served on scientific advisory boards sponsored by Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GSK, Grifols, Insmed, Menarini, Novartis, Nuvaira, Roche, and Sanofi outside the submitted work. Daiana Stolz received payments or honoraria for lectures, presentations, advisory boards, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Berlin-Chemie/Menarini, Boehringer Ingelheim, Chiesi, CSL Behring, Curetis, GSK, Merck, MSD, Novartis, Roche, Sanofi and Vifor outside the submitted work. Sebastian Fähndrich received fees for lectures and travel support from CSL Behring, Grifols, AstraZeneca, BerlinChemie. Sebastian Fähndrich’s research is supported by the German Federal Ministry of Education and Research (BMBF) and by the European Union (ISIDORe).