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The GutLung Axis Lung microbiota has recently got into the focus of scientific interest

Key Limitation The intranasal route was ultimately not pursued for regulatory approval due to: Lower and less predictable bioavailability Increased incidence of transient blood pressure elevations Higher variability in pharmacokinetics Subcutaneous injections provided a more reliable and consistent route for clinical use

Conclusion: The newly proposed COSMOS scale demonstrated substantial inter-rater and intra-rater reliability

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