{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:03Z","timestamp":1782366483234,"version":"3.54.5"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Chinese continent is grappling with a rising prevalence of chronic obstructive pulmonary disease (COPD) in conjunction with the growing threat of climate change and its associated extreme temperature. This systematic review aims to assess the relationship between extreme temperature exposures (heat and cold exposure) and COPD health outcomes in Chinese populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This study will assess the relationship between extreme temperature exposures and COPD health outcomes through a systematic review and meta-analysis. Observational studies meeting the inclusion criteria will be included, and the Population-Exposure-Comparator-Outcome-Study (PECOS) research design standard will be adopted to examine how extreme temperatures impact COPD-related mortality and morbidity including hospitalizations and acute exacerbations. A literature search will be conducted across multiple databases, including PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure (CNKI), WANGFANG Data, VIP and Sinomed. We will evaluate the reporting quality, methodological quality and evidence quality of these observational, cohort, and cross-sectional studies using Risk of Bias in Non-randomized Studies-of Environmental Exposure (ROBINS-E) assessment tool, and integrate the evidence within the GRADE framework. Additionally, the analysis of outcomes will be performed using the narrative synthesis and R software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval is not required for this review. The results of this study will be disseminated through publication in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study protocol registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261281322<\/jats:ext-link>\n                      , identifier (CRD420261281322).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1873054","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:30:04Z","timestamp":1782365404000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between extreme temperature exposure and COPD health outcomes in China: study protocol for a systematic review"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiaxin","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]},{"name":"Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Construction by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]},{"name":"Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Construction by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]},{"name":"Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Construction by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianya","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]},{"name":"Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Construction by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]},{"name":"Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]},{"name":"Henan International Joint Laboratory of Evidence-based Evaluation for Respiratory Diseases, Henan Province Clinical Research Center for Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suyun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]},{"name":"Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Construction by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]},{"name":"Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]},{"name":"Henan International Joint Laboratory of Evidence-based Evaluation for Respiratory Diseases, Henan Province Clinical Research Center for Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/S0140-6736(06)68079-3","article-title":"Climate change and human health: present and future risks","volume":"367","author":"McMichael","year":"2006","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/S0140-6736(20)32290-X","article-title":"The 2020 report of the lancet countdown on health and climate change: responding to converging crises","volume":"397","author":"Watts","year":"2021","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2475","DOI":"10.1186\/s12889-024-19947-z","article-title":"Burden of non-communicable diseases attributable to high temperature in a changing climate from 1990 to 2019:a global analysis","volume":"24","author":"Zhang","year":"2024","journal-title":"BMC Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"04017","DOI":"10.7189\/jogh.14.04017","article-title":"Rising trend and regional disparities of the global burden of disease attributable to ambient low temperature, 1990-2019: An analysis of data from the global burden of disease 2019 study","volume":"14","author":"Liu","year":"2024","journal-title":"J Glob Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"147540","DOI":"10.1016\/j.scitotenv.2021.147540","article-title":"Ambient high temperature exposure and global disease burden during 1990-2019: an analysis of the global burden of disease study 2019","volume":"787","author":"Song","year":"2021","journal-title":"Sci Total Environ"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1016\/S0140-6736(18)30841-9","article-title":"Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China pulmonary health [CPH] study): a national cross-sectional study","volume":"391","author":"Wang","year":"2018","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12940-015-0012-0","article-title":"The effect of heat waves on mortality in susceptible groups: a cohort study of a mediterranean and a northern European City","volume":"14","author":"Oudin \u00c5str\u00f6m","year":"2015","journal-title":"Environ Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1093\/eurjpc\/zwae021","article-title":"Ambient temperature and risk of cardiovascular and respiratory adverse health outcomes: a nationwide cross-sectional study from Spain","volume":"31","author":"Achebak","year":"2024","journal-title":"Eur J Prev Cardiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1136\/thoraxjnl-2021-218374","article-title":"Ambient heat exposure and COPD hospitalisations in England: a nationwide case-crossover study during 2007-2018","volume":"77","author":"Konstantinoudis","year":"2022","journal-title":"Thorax"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e57066","DOI":"10.1371\/journal.pone.0057066","article-title":"The effect of cold temperature on increased exacerbation of chronic obstructive pulmonary disease:a nationwide study","volume":"8","author":"Tseng","year":"2013","journal-title":"PLoS One"},{"key":"ref11","volume-title":"Global Initiative for Chronic Obstructive Lung Disease. 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