a multinational longitudinal study

Funding Information: Acknowledgements: We thank all participants and staff for their time and effort put into this study. Infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre (BRC). Funding Information: National Heart and Lung Institute, UK Medical Research Council, and Wellcome Trust.We thank all participants and staff for their time and effort put into this study. Infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre (BRC). Funding Information: Declaration of interests: DM declares being a consultant to and receiving royalties from GlaxoSmithKline, AstraZeneca, and the COPD Foundation (royalty payments are up to date) and acting as an expert witness for Schlesinger Law Firm, outside of the submitted work. RN reports grants and personal fees from AstraZeneca and GlaxoSmithKline and grants from Boehringer Ingelheim and Novartis, outside of the submitted work. FR reports grants and personal fees from A. Menarini, Boehringer Ingelheim, Teva Pharma, Novartis, GlaxoSmithKline, AstraZeneca, VitalAire and Nippon Gases outside the submitted work. FF reports consulting fees from Sanofi and MSD, as well as personal and institutional fees from Sanofi, AstraZeneca, Chiesi, GSK and Pfizer, outside of the submitted work. AA reports research grants from the COLT foundation outside of the submitted work. All other authors declare no competing interests. Publisher Copyright: © 2025 The Author(s)