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Article History

Received: 13 July 2025

Accepted: 15 November 2025

First Online: 29 November 2025

Declarations

:

: For participating Dutch centres, the study protocol (CMO 2016–3037) was reviewed and approved by the ethics board region Arnhem-Nijmegen before study initiation. Based on the study’s observational nature, written informed consent was waived. Patients were not included if they (or their legal representatives) actively objected to participation.For participating Belgian centres, the study protocol was reviewed and approved by their individual ethical committees (S60757). Written informed consent was obtained for all Belgian participants.Participants in the POSA-FLU trial all provided written informed consent. This study’s protocol was reviewed and approved by the ethics board region Arnhem-Nijmegen for all Dutch participating sites (CMO 2018–4041) and by the ethical committees of all participating centres in Belgium (S60744).This study was performed in accordance with the latest version of the declaration of Helsinki and local legislation/regulations.

: Not applicable.

: NAFJ reports having been a local (principal) investigator for an industry-sponsored trial for Pulmatrix, Inc. (payments to institution), outside the submitted work. LV reports fees from Pfizer and support for attending meetings and/or travel from Pfizer and Gilead Sciences, outside the submitted work. SF reports fees from HealthBook Company Ltd., Pfizer, Gilead and MundiPharma and support for attending meetings and/or travel from Pfizer and Gilead, outside the submitted work. KvD reports fees from Gilead and Pfizer (paid to institution) and participating on advisory boards for Gilead and Pfizer (payments to institution), outside the submitted work. KL reports grants from TECOmedical (paid to institution), consulting fees from MundiPharma (paid to institution), fees from Gilead, Pfizer, MundiPharma and FUJIFILM Wako Chemicals Europe GmbH (the latter two paid to institution), support for attending meetings and/or travel from Gilead, Pfizer and AstraZeneca and participation on a Data Safety Monitoring Board or Advisory Board for Pfizer (paid to institution), all outside the submitted work. RJMB reports grants from Gilead and Pfizer and consulting fees and payment for expert testimony from Basilea, F2G, Gilead, Pfizer, Astellas, MundiPharma and Pulmocide, all outside the submitted work. PEV reports fees from MundiPharma and Gilead Sciences (paid to institution), outside the submitted work. JW reports investigator-initiated grants from Gilead, Pfizer and MundiPharma, speaker’s fees from Gilead, Pfizer, MundiPharma and AstraZeneca and support for attending meetings and/or travel from Gilead, Pfizer and MundiPharma, all outside the submitted work. FLvdV reports grants from the European Union’s Horizon 2020 research and innovation programme, outside the submitted work. All other authors declare that they have no competing interests.