Increased vulnerability of COPD patient groups to urban climate in view of global warming.

Purpose: Patients with COPD show an increase in acute exacerbations (AECOPD) during the cold season as well as during heat waves in the summer months. Due to global climate changes, extreme weather conditions are likely to occur more frequently in the future. The goal of this study was to identify patient groups most at risk of exacerbations during the four seasons of the year and to determine at which temperature threshold the daily hospital admissions due to AECOPD increase during the summer.

Patients and methods: We analyzed retrospective demographic and medical data of 990 patients, who were hospitalized for AECOPD in Berlin, Germany. The cases were grouped into the following cohorts: "spring" (admission between March and May), "summer" (June - August), "autumn" (September - November), and "winter" (December - February). AECOPD hospital admissions from 2006 and 2010 were grouped into a "hot summer" cohort and cases from 2011 and 2012 into a "cold summer" data-set. Climate data were obtained from the German Meteorological Office.

Results: Patients hospitalized for a COPD exacerbation during winter were significantly older than summertime patients ( P =0.040) and also thinner than patients exacerbating in spring ( P =0.042). COPD exacerbations during hot summer periods happened more often to patients with a history of myocardial infarction ( P =0.014) or active smokers ( P =0.011). An AECOPD during colder summers occurred in patients with a higher Charlson index, who suffered in increased numbers from peripheral vascular diseases ( P =0.016) or tumors ( P =0.004). Summertime hospital admissions increased above a daily minimum temperature of 18.3°C ( P =0.006).

Conclusion: The identification of COPD patient groups most at risk for climate related exacerbations enables climate-adapted prevention through patient guidance and treatment. In view of global climate changes, discovering vulnerabilities and implementing adaptive measures will be of growing importance.