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Updated: Oct 24, 2026

Alternative Therapy for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Moving Cupping Along Meridians
Published on: September 27, 2024
Distinct seasonal lag patterns for cold- and heat-related chronic obstructive pulmonary disease exacerbations: a
Chung Ho Kim1, Yeonjae Kim1, Changhyun Jun2
1Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
Background:
Ambient temperature has been associated with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but evidence on seasonal lag patterns and susceptible populations remains limited. We characterized lag-specific and cumulative temperature-AECOPD associations during cold and warm seasons.
Methods:
Using the Korean National Health Insurance Service-National Sample Cohort (2006-2019), we conducted a time-stratified case-crossover study with referent days matched by year, season, and day of the week. Cold-season exposure was defined as 2-m air temperature (November-April), and warm-season exposure as wet-bulb globe temperature (WBGT; May-October). Conditional quasi-Poisson distributed lag non-linear models estimated lag-specific and cumulative relative risks (RRs) over 0-28 days, adjusting for season-specific meteorological variables, PM10, PM2.5, and public holidays. Effect modification by age, sex, smoking, and body mass index (BMI) was examined.
Results:
Among 5981 AECOPD events, lower cold-season temperatures were associated with delayed, sustained risk increases over lag days 6-23, peaking at lag 14-18 (RR = 1.23; 95% confidence interval (CI) 1.04-1.46). Higher warm-season WBGTs were associated with an immediate increase, peaking at lag 0-1 (RR = 1.06; 95% CI 1.02-1.10), which attenuated within 1 week. Cumulative exposure-response curves were monotonic for cold-season temperature and inverted U-shaped for warm-season WBGT. Associations were stronger in men, older adults, smokers, and those with a BMI ≥25.
Conclusion:
Cold- and warm-season ambient temperature metrics showed distinct temporal associations with AECOPD, delayed in the cold season and immediate in the warm season. Associations appeared relatively stronger among older adults, men, smokers, and individuals with higher BMI.
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