The impact of personal and outdoor temperature exposure during cold and ...

ERJ OPEN RESEARCH ORIGINAL RESEARCH ARTICLE

C. SCHEERENS ET AL.

The impact of personal and outdoor temperature exposure during cold and warm seasons on lung function and respiratory symptoms in COPD

Charlotte Scheerens1,2, Lina Nurhussien1, Amro Aglan1, Andrew J. Synn 1, Brent A. Coull3,4, Petros Koutrakis3 and Mary B. Rice 1

1Division of Pulmonary, Sleep and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 2Dept of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium. 3Dept of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA. 4Dept of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.

Corresponding author: Charlotte Scheerens (charlotte.scheerens@ugent.be)

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Higher temperature, including outdoor exposure during the warm season and personal exposure year-round, may worsen dyspnoea while colder outdoor temperature may trigger cough and phlegm symptoms in COPD patients

Cite this article as: Scheerens C, Nurhussien L, Aglan A, et al. The impact of personal and outdoor temperature exposure during cold and warm seasons on lung function and respiratory symptoms in COPD. ERJ Open Res 2022; 8: 00574-2021 [DOI: 10.1183/23120541.00574-2021].

Copyright ?The authors 2022

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Received: 4 Oct 2021 Accepted: 28 Dec 2021

Abstract Rationale Chronic obstructive pulmonary disease (COPD) patients often report aggravated symptoms due to heat and cold, but few studies have formally evaluated this. Methodology We followed 30 Boston-based former smokers with COPD for four non-consecutive 30-day periods over 12 months. Personal and outdoor temperature exposure were measured using portable and Boston-area outdoor stationary monitors. Participants recorded daily morning lung function measurements as well as any worsening breathing (breathlessness, chest tightness, wheeze) and bronchitis symptoms (cough, sputum colour and amount) compared to baseline. Using linear and generalised linear mixed-effects models, we assessed associations between personal and outdoor temperature exposure (1?3-day moving averages) and lung function and symptoms, adjusting for humidity, smoking pack-years and demographics. We also stratified by warm and cold season. Results Participants were on average 71.1?8.4 years old, with 54.4?30.7 pack-years of smoking. Each 5?C increase in personal temperature exposure was associated with 1.85 (95% CI 0.99?3.48) higher odds of worsening breathing symptoms. In the warm season, each 5?C increase in personal and outdoor temperature exposure was associated with 3.20 (95% CI 1.05?9.72) and 2.22 (95% CI 1.41?3.48) higher odds of worsening breathing symptoms, respectively. Each 5?C decrease in outdoor temperature was associated with 1.25 (95% CI 1.04?1.51) higher odds of worsening bronchitis symptoms. There were no associations between temperature and lung function. Conclusions Our findings suggest that higher temperature, including outdoor exposure during the warm season and personal temperature exposure year-round, may worsen dyspnoea, while colder outdoor temperature may trigger cough and phlegm symptoms among COPD patients.

Background Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world, with global burden and mortality expected to continue rising in the coming decades [1]. Symptoms of COPD include chronic cough, production of phlegm (mucus) and dyspnoea [2]. The disease course often involves a progressive, inexorable functional decline with acute episodes of exacerbation [3].

Increasing attention is being given to the effects of weather exposure in the context of climate change [4]. Extremes of temperature such as heat waves, hot weather and extended periods of cold may negatively



ERJ Open Res 2022; 8: 00574-2021

ERJ OPEN RESEARCH

ORIGINAL RESEARCH ARTICLE | C. SCHEERENS ET AL.

affect lung function and symptom burden in COPD. In fact, COPD patients often report susceptibility to temperature and weather changes [5?8]. Both summer heat [5, 6, 8] and winter cold [7, 9, 10] have been associated with increased COPD hospitalisations and symptom burden. For example, MCCORMACK et al. [6] found that higher maximal indoor temperature during the warm season in Baltimore was associated with worsened breathlessness, cough and sputum, and increased rescue inhaler use among COPD patients. Similarly, MCCORMACK et al. [7] found that colder temperatures in the cold season were associated with respiratory symptoms and lower lung function.

Few studies have evaluated whether temperature affects individual-level COPD morbidity indictors, including daily changes in respiratory symptoms and lung function, that may precede healthcare utilisation for COPD [6, 7]. Most studies have relied on community-level monitors or brief sampling periods to estimate exposure to temperature, which may not capture personal exposure to temperature, especially among COPD patients who spend most of their time at home. New methods, using portable monitors that patients bring along during their indoor and outdoor activities, allow for daily evaluation of personal exposure to temperature [11]. This study examines how daily personal and outdoor temperature exposure in the warm (May?September) and cold (October?April) seasons affect daily lung function, breathing and bronchitis symptoms among community-dwelling COPD patients, using both portable and stationary monitors in the greater Boston area.

Materials and methods Study population The study population included 30 former smokers with COPD who were recruited as part of the Study of Air Pollution and COPD Exacerbation (SPACE) at the Beth Israel Deaconess Medical Center (Boston, MA, USA). This study was conducted in accordance with the Declaration of Helsinki and was approved by the Committee on Clinical Investigations at Beth Israel Deaconess Medical Center (IRB protocol number: 2015P000336/06). To be eligible, study participants were required to 1) have a home address within 50 km of the Harvard Supersite air pollution and temperature monitor at Harvard Medical School in Boston and 2) have a clinical diagnosis of COPD with at least moderate (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2) airflow obstruction, defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio of ................
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