title: The effect of cold temperature on increased exacerbation of chronic obstructive pulmonary disease: a nationwide study.
abstract: BACKGROUND
  Seasonal variations in the acute exacerbation of chronic obstructive pulmonary disease (COPD) have been reported. However, the influence of air temperature and other meteorological factors on COPD exacerbation remains unclear.
  
  
  METHODS
  National Health Insurance registry data from January 1, 1999 to December 1, 2009 and meteorological variables from the Taiwan Central Weather Bureau for the same period were analyzed. A case-crossover study design was used to investigate the association between COPD exacerbation and meteorological variables.
  
  
  RESULTS
  A total of 16,254 cases who suffered from COPD exacerbation were enrolled. We found that a 1°C decrease in air temperature was associated with a 0.8% increase in the exacerbation rate on event-days (95% confidence interval (CI), 1.015-1.138, p = 0.015). With a 5°C decrease in mean temperature, the cold temperature (28-day average temperature) had a long-term effect on the exacerbation of COPD (odds ratio (OR), 1.106, 95% CI 1.063-1.152, p<0.001). In addition, elderly patients and those who did not receive inhaled medication tended to suffer an exacerbation when the mean temperature dropped 5°C. Higher barometric pressure, more hours of sunshine, and lower humidity were associated with an increase in COPD exacerbation.
  
  
  CONCLUSIONS
  This study demonstrated the effect of cold temperatures on the COPD exacerbation rate. Elderly patients and those without inhaled medicine before the exacerbation event were affected significantly by lower mean temperatures. A more comprehensive program to prevent cold stress in COPD patients may lead to a reduction in the exacerbations rate of COPD.
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Ching-Min
authors.initials: CM
authors.lastname: Tseng
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.forename: Yi-Han
authors.initials: YH
authors.lastname: Hsiao
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Li
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
authors.forename: Albert C
authors.initials: AC
authors.lastname: Yang
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Diahn-Warng
authors.initials: DW
authors.lastname: Perng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003080:Cold Temperature; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology*; D012042:Registries; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
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