COPD risk due to extreme temperature exposure: combining epidemiological evidence with pathophysiological mechanisms.

Climate change is amplifying the frequency and intensity of extreme temperature events, posing a significant risk for chronic obstructive pulmonary disease (COPD). This review synthesised epidemiological evidence linking extreme temperature to COPD morbidity and mortality, while elucidating synergistic interactions with other environmental exposures. Combining population-level findings with biomedical mechanistic insights, we proposed a framework illustrating how biomarkers bridge the gap between extreme temperature exposure and COPD, highlighting the pathophysiological mechanisms of prodromal symptoms, key pathogenic processes and early molecular events. The mechanisms and biomarkers identified in this study would provide critical information for elucidating the causal pathways through which extreme temperatures increase COPD risk, and thus inform preventive interventions. Future research should incorporate multi-omics techniques to explore the underlying mechanisms in greater depth, while validating the biomarkers through large-scale cohort studies.