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The presence of aspergillus has been associated with a higher frequency of exacerbations.58 In terms of the virome, influenza A and B, adenovirus, parainfluenza, rhinovirus and human T lymphotropic virus-1 have been identified59 with a consistently high frequency, even during periods of stability.60 Additionally, the potential role of bacteriophage viruses in maintaining microbiome stability should be noted61 (Fig

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Conflicts of Interest The author declares no conflicts of interest in this work