The associations of long-term temperature and precipitation with chronic respiratory symptoms: Projections for the changing climate

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Methods An e-mail survey was directed to the members of the Finnish Pensioners` Federation. The mean 20-years’ precipitation and temperature in each subjects’ home municipality were obtained from the Finnish Meteorological Institute, separately for summer and winter. Adjusted multivariate models were utilized to investigate the associations of the climatic indices with chronic rhinosinusitis, chronic cough, wheezing with dyspnea, and sleep apnea. Results There were 6189 responders from 283 municipalities. Chronic rhinosinusitis and chronic cough were most prevalent in the southeastern regions of the country, where the precipitation counts were highest. In the multivariate models, winter precipitation in the home municipality increased the risks of chronic rhinosinusitis and chronic cough (adjusted OR 1.79 (1.29-2.49) per 100 mm, p < 0.001, and 1.57 (1.19 to 2.07), p = 0.001, respectively). Wheezing with dyspnea and sleep apnea were not associated with the climatic indices. Conclusion Chronic rhinosinusitis and chronic cough were associated with long-term winter precipitation. Given the anticipated increase in winter precipitation in Northern America and Northern Europe, the prevalences of chronic rhinosinusitis and chronic cough may increase there. cough chronic cough asthma wheezing rhinitis chronic rhinosinusitis sleep apnea climate climate change Figures Figure 1 Figure 2 Figure 3 Introduction The temperatures are rising globally, accompanied by changes in precipitation patterns [ 1 , 2 ]. The speed of global warming is especially rapid in the arctic area, including Northern America and Northern Europe. This is accompanied with an increase in precipitation, especially during the wintertime [ 3 – 5 ]. Respiratory symptoms constitute a large proportion of reasons why people seek medical attention [ 6 ]. Therefore, any effect of the climate change on their prevalence is a fundamental health policy issue. It has been widely recognized that more research is needed to assess the burden of climate change on respiratory diseases that may be translated into public health policies. Previous studies about climate and respiratory symptoms often focus on extreme, short-term climatic conditions [ 7 , 8 ]. Less is known about the effect of long-term changes in climate on chronic respiratory symptoms. Finland is a culturally homogeneous country situated in Northern Europe, where the change in climate is rapid [ 3 – 5 ]. The country is long in the north-south direction with considerable within-country climatic differences. The most southern part of Finland has hemiboreal climate whereas a large area in the north has hemiarctic climate [ 9 ]. For these reasons, it is a suitable area to investigate the associations between chronic respiratory symptoms and climatic indices. In the present study, we focused on four symptoms that could be clearly defined according to the current literature. We included the long-term average temperature and precipitation in the subjects’ home municipality in the multivariate models about the risk of these symptoms. Finally, we estimated the effect of the anticipated change in the temperature and precipitation on the risk of the symptoms. Material and methods The target population This cross-sectional email survey was originally conducted to estimate the prevalence, risk factors and consequences of chronic cough in elderly subjects [ 10 ]. It was directed to the members of the Finnish Pensioners` Federation (26 205 members with an email address, mean age 72.7 years, 63.5% female). The subjects were sent an information letter, invitation, and the questionnaire in April 2021. A reminder message was sent 2 weeks later. The data was collected electronically. A filled questionnaire was considered as an informed consent. The study follows the World Medical Association's Declaration of Helsinki and was approved by the Ethics Committee of Kuopio University Hospital (289/2015). The Finnish Pensioners` Federation permitted the conduct of this study. Questionnaire All subjects answered 62 questions about age, socioeconomic status, smoking, lifestyle, recently experienced symptoms, general health, disorders diagnosed by a doctor, medication, healthcare use within the past year, and symptom sum. It was calculated by summing up the following non-respiratory, non-mental symptoms in the past month: Chest pain on exertion, aching joints, back pain, sciatica (back pain that radiates to the leg), toothache, swollen feet, headache, constipation, other gut problems (flatulence, diarrhea), and urinary problems. Ever smoking was defined as daily smoking for more than one year ever in lifetime. The subjects were asked whether there was moisture damage identified in their home during the past 12 months. They were also asked about their current home municipality and region. Definitions of the respiratory symptoms Chronic rhinosinusitis was present if there was either nasal blockage or discharge, and either reduction/loss of smell or facial pain/pressure for ≥ 3 months within the past year [ 11 ]. Chronic cough was defined as current cough which had lasted > 8 weeks [ 12 , 13 ]. Wheezing with dyspnea was defined as positive answers to both of the following questions: “In the past year (12 months), have you experienced wheezing or a whistling sound when you breathe“ and “Have you experienced a shortness of breath at the same time when your breathing is wheezy or whistling” [ 14 ]. Sleep apnea was defined as presence of ≥ 2 of the following features: Loud snoring, daytime tiredness, observed apneas and arterial hypertension (the STOP-questionnaire) [ 15 ]. Information about the home municipality and the home region The mainland Finland consists of 18 regions, which are divided to municipalities, 293 altogether. For each home region and municipality, the mean annual precipitation, mean winter (November - April) precipitation, mean summer (May - October) precipitation, mean annual temperature, mean winter temperature, and mean summer temperature for the years 2000–2021 were kindly provided by the Finnish Meteorological Institute. In addition, each municipality was classified as urban, semi-urban, or rural, according to the classification by the Statistics Finland [ 16 ]. Statistical analysis The relative prevalence of the respiratory symptoms in each region was calculated as the prevalence in the region divided by the mean prevalence in Finland. Two small regions (Ostrobothnia and Central Ostrobothnia) were combined to achieve at least 100 responders for each region. The associations of the respiratory symptoms with the climatic indices in the home municipality were assessed utilizing bivariate and multivariate logistic regression analyses with a backward directed stepwise procedure. The annual precipitation was expressed as hundreds of mm. In the multivariate models, the following covariates were included: Age, body mass index, gender, ever smoking daily at least one year, family incomes, the classification of the municipality, and symptom sum. SPSS software version 29.0.1.0 (IBM SPSS Statistics for Windows) was utilized and a p-value < 0.05 was considered statistically significant. The descriptive data is expressed as percentages or means and 95% confidence intervals (CI) and the risks as odds ratios (OR) and CIs. Results The response rate was 23.6% (n = 6189, Table 1 ) representing all regions and 282 municipalities. The proportion of missing values was < 2.5%, except for the question about family income (2.9%) and the sleep apnea-related questions (3.1–3.7%). The home municipality and region could not be assessed for 34 subjects (0.5%). 88 subjects (1.4%) reported about moisture damage in their home during the past 12 months. Table 1 The basic characteristics of the 6189 responders. The figures are means and 95% confidence intervals or percentages. The numbering of the regions corresponds to the official numbering in Finland and those in the maps. Age (Years) 72.2 (72.08–72.35) Female gender (%) 66.5 Body mass index (kg/m 2 ) 27.4 (27.3–27.5) Yearly family incomes less than 15 000 e (%) 8.2 15 000–40 000 e (%) 53.3 40 000–70 000 e (%) 31.1 70 000–120 000 e (%) 6.7 More than 120 000 e (%) 0.7 Type of current home municipality Urban (%) 49.3 Semi-urban (%) 23.8 Rural (%) 26.9 Current smokers (%) 1.8 Ever smokers (%) 36.2 Subjects with chronic rhinosinusitis (%) 9.7 Subjects with current chronic cough (%) 13.7 Subjects with wheezing and dyspnea during the last 12 months (%) 8.9 Subjects with sleep apnea (%) 32.8 Current home region (the numbers on the maps) Uusimaa (1) (%) 12.4 Southwest Finland (2) (%) 14.7 Satakunta (4) (%) 2.8 Kanta-Häme (5) (%) 5.1 Pirkanmaa (6) (%) 5.8 Päijät-Häme (7) (%) 2.9 Kymenlaakso (8) (%) 3.4 South Karelia (9) (%) 2.6 South Savo (10) (%) 5.5 North Savo (11) (%) 7.6 North Karelia (12) (%) 4.7 Central Finland (13) (%) 5.9 South Ostrobothnia (14) (%) 8.8 Ostrobothnia and Central Ostrobothnia joined (16) (%) 3.0 North Ostrobothnia (17) (%) 7.9 Kainuu (18) (%) 2.7 Lapland (19) (%) 3.9 Chronic rhinosinusitis and chronic cough were most prevalent in the south-eastern regions (Fig. 1a, b). Wheezing with dyspnea and sleep apnea showed no clear regional patterns (data not shown). The long-term winter precipitation was highest in the south-eastern regions (Fig. 2) whereas the long-term temperatures were highest in the south-western regions (Fig. 3). In the bivariate and multivariate logistic regression analyses, chronic rhinosinusitis and chronic cough were statistically significantly associated with the mean annual precipitation in the home municipality and especially, with the mean winter precipitation (Tables 2 , 3 ). In addition, chronic cough showed a weak association with summer temperature. Wheezing with dyspnea and sleep apnea were not associated with the climatic indices. Table 2 The bivariate associations between the respiratory symptoms and the mean climatic conditions during the years 2000–2021 in the current home municipality. The figures represent odds ratios calculated by logistic regression analyses. Climatic indices Chronic rhinosinusitis Chronic cough Wheezing with dyspnea Sleep apnea Yearly precipitation 1.58 (1.26–1.98)*** 1.34 (1.10–1.62)** 1.15 (0.91–1.45) 0.98 (0.85–1.13) Winter precipitation 1.93 (1.40–2.65)*** 1.63 (1.24–2.14)*** 1.13 (0.81–1.56) 0.98 (0.80–1.20) Summer precipitation 1.64 (1.07–2.53)* 1.20 (0.83–1.74) 1.35 (0.86–2.12) 0.96 (0.72–1.27) Yearly temperature 1.03 (0.97–1.10) 1.06 (1.00-1.12) 0.98 (0.91–1.04) 0.99 (0.95–1.03) Winter temperature 1.02 (0.97–1.07) 1.04 (0.99–1.08) 0.97 (0.93–1.02) 0.99 (0.96–1.03) Summer temperature 1.08 (0.98–1.18) 1.10 (1.02–1.20)* 0.99 (0.90–1.09) 0.98 (0.93–1.04) The ORs for the precipitation are calculated per 100 mm, the ORs for the temperatures per one o C. * p < 0.05; ** p < 0.01; *** p < 0.001 Table 3 The multivariate associations between the respiratory symptoms and the mean climatic conditions during the years 2000–2021 in the current home municipality. The following covariates were included: Age, body mass index, gender, ever smoking daily at least one year, family incomes, the classification of the municipality, and symptom sum. The figures represent adjusted odds ratios calculated by logistic regression analyses. Climatic indices Chronic rhinosinusitis Chronic cough Wheezing with dyspnea Sleep apnea Yearly precipitation 1.53 (1.21–1.93)*** 1.32 (1.09–1.60)** 1.11 (0.87–1.42) 1.00 (0.85–1.16) Winter precipitation 1.79 (1.29–2.49)*** 1.57 (1.19–2.07)** 1.06 (0.75–1.51) 0.97 (0.78–1.21) Summer precipitation 1.67 (1.07–2.61)* 1.28 (0.87–1.84) 1.37 (0.85–2.20) 1.05 (0.77–1.42) Yearly temperature 1.03 (0.96–1.10) 1.05 (0.99–1.11) 0.97 (0.90–1.04) 0.97 (0.93–1.02) Winter temperature 1.01 (0.96–1.07) 1.02 (0.98–1.07) 0.97 (0.92–1.02) 0.98 (0.95–1.01) Summer temperature 1.07 (0.97–1.17) 1.09 (1.01–1.18)* 0.98 (0.89–1.09) 0.96 (0.90–1.02) The ORs for the precipitation are calculated per 100 mm, the ORs for the temperatures per one o C. * p < 0.05; ** p < 0.01; *** p < 0.001 Discussion In this study among elderly Finnish subjects, chronic rhinosinusitis and chronic cough were associated with the long-term mean winter precipitation in the home municipality, whereas wheezing with dyspnea and sleep apnea were not associated with any climatic indices. The results suggest different contributions of climate on different chronic respiratory symptoms. Previous studies about climate and respiratory symptoms often focus on extreme, short-term climatic conditions [ 8 ]. A large survey in 32 countries showed that in humid, subtropical regions, anomalously wet conditions increase the risk of cough [ 23 ]. A Japanese study found the mean vapor pressure to be the most important environmental factor associated with acute exacerbation of nonallergic rhinitis [ 24 ]. Our findings suggest that even mild, but long-lasting or repetitive high precipitation may increase the risks of chronic rhinosinusitis and chronic cough. In Nordic countries like Finland, much of the winter precipitation comes in the form of snow. Thus, a large proportion of water is in a solid state until spring, when it melts during a relative short period in March-April. At that stage, a large amount of water is released. This may be regarded as minor flooding, though it is a normal annual phenomenon. These minor annual floods may be, at least partly, responsible for the associations of chronic rhinosinusitis and chronic cough with high winter precipitation. Of note, the present survey was performed in April, in the middle of the melting period. This may have affected the results. The association of high winter precipitation with the risks of chronic rhinosinusitis and chronic cough may mediate via an increase in the indoors humidity. People spend most of their time indoors and indoors absolute humidity correlates well with the outdoors absolute humidity throughout the year [ 17 , 18 ]. High indoors humidity is well known to associate with cough and nasal symptoms. Under such conditions, the building occupants may be exposed to increased levels of microbial agents such as fungal spores, formaldehyde from building materials, as well as odors, microparticles and vapors [ 19 – 22 ]. However, just 1.4% of the subjects in the present survey reported about moisture damage in their home. Due to the low prevalence of moisture damage, its regional distribution could not be assessed in the present study. Another explanation for the association between high precipitation and respiratory symptoms is that high precipitation may increase the pollen concentrations. The association between precipitation and the pollen load is complex. Rainfall during the flowering season decreases the pollen load whereas high precipitation during months preceding the pollination may increase it [ 25 ]. Winter precipitation probably precedes pollination and therefore, high winter precipitation could intensify the pollination. Unfortunately, we did not have information about local pollen counts for the present study, which can be regarded as a weakness. It may be plausible to assume that the direct or indirect effects of excessive ambient moisture on respiratory symptoms mediate by altering the function of the airway epithelium. Chronic rhinosinusitis, chronic cough, and wheezing with dyspnea all may involve a dysfunctional airway epithelial barrier [ 26 ]. Therefore, it is interesting that only chronic rhinosinusitis and chronic cough were associated with high winter precipitation. We suggest three possible explanations. Firstly, the nose plays a primary role within the airways, working as a filter and air-conditioner [ 27 ]. Thus, it is probable that the effects of high indoors humidity or high pollen load affects more the nose than the lower airways [ 28 ]. Secondly, chronic rhinosinusitis is a well-known cause for chronic cough [ 12 , 13 ]. Thirdly, wheezing with dyspnea is typical for asthma, which is a very strongly genetically determined disorder [ 29 , 30 ]. Thus, environmental factors may play a minor role. The recently updated climate change scenarios indicate that the winter precipitation may increase up to 40% during the current century in Finland, indicating almost 100 mm increase [ 4 ]. Our multivariate model suggest that this could increase the risk of chronic rhinosinusitis by 79% and the risk of chronic cough by 57%. These are alarming figures given the high prevalence and the high health resource utilization due to these symptoms [ 6 ]. However, projections to the future are complicated and our results should be interpreted with caution. For example, despite the increasing winter precipitation, the snow cover tends to get thinner in the Northern Hemisphere due to warming of the winters [ 31 ]. This probably decreases the amounts of water released during the melting period in spring. In addition, climate change probably leads to many other environmental phenomena. These include the intensification of pollen and other bioallergenic proteins production, including bacteria, viruses, animal dander, insects, molds, and plant species. Furthermore, climate change may also influence the ambient concentrations of air pollutants including carbon monoxide, lead, nitrogen dioxide, ozone, particulate matter, and sulfur dioxide. These variables could not be taken into account in the present study but are a capable to affect, and probably increase further, the risks of chronic rhinosinusitis and chronic cough in the future [ 8 ]. The present cross-sectional survey can only reveal associations, not causal relationships. Other weaknesses of the study include the limited generalizability of the results: They may only apply to countries with cool climate and an increase in precipitation due to climate change. In many other areas of the word, the climate change probably decreases precipitation [ 1 ]. In the present study, the associations between long-term temperatures and respiratory symptoms were weak or absent. This may be since people spend most of their time indoors and that in cool climates like that in Finland, indoors temperatures are kept rather stable throughout the year. In areas with warmer climate, the situation is different and the indoors air temperatures correlate better with the outdoors temperature [ 17 , 18 , 32 , 33 ]. Furthermore, the present population was old, and the results may not be directly applicable to younger subjects. The participation rate was low, but the age and gender distribution of the responders closely resembled that of the target population. The main strength of the present study is the accurate information about the long-term mean temperatures and precipitations in each subjects’ home municipality. The respiratory symptoms were strictly defined as currently suggested in the literature. Furthermore, many factors that could affect the risk of respiratory symptoms could be considered in the multivariate analyses: Smoking, socio-economical state, urban versus rural municipality, and the individual differences in experiencing and reporting of bodily sensations, which was covered by the variable ‘symptom sum’ [ 34 , 35 ]. In conclusion, chronic rhinosinusitis and chronic cough showed strong associations with long-term winter precipitation in the home municipality. Given the anticipated rapid increase in winter precipitation in Northern America and Northern Europe due to climate change, these symptoms may become more prevalent and present an increasing burden on primary health care. However, more reliable projections for the future would require more comprehensive information about other climate change-associated phenomena. Declarations Acknowledgements: The authors thank Seppo Hartikainen from Istekki Ltd for the assistance in modifying the electronic questionnaire, Kirsti Jylhä and Ville Siiskonen from the Finnish Meteorological Institute for the climatic data and for the help to interpret this data. Funding: This study was supported by Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö foundations. They had no role in the planning or analysis of present study. Competing interests: Heikki O Koskela has received funding for the present study from Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö Foundations, payments for lectures from Boehringer Ingelheim and MSD, and owns shares of a medical company Orion. Johanna T Kaulamo has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, Suomen Tuberkuloosin vastustamisyhdistyksen Säätiö, Väinö ja Laina Kiven Säätiö, and Suomen Kulttuurirahasto foundations, and travel support from Boehringer-Ingelheim for attending a scientific meeting. Anne M Lätti has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, KYS:n Tutkimussäätiö, Suomen Tuberkuloosin Vastustamisyhdistyksen Säätiö, and Väinö ja Laina Kiven Säätiö Foundations, travel support from Orion, Boehringer Ingelheim and Roche for attending a scientific meeting, and payment for lectures and Advisory Board participations from Farmasian oppimiskeskus, MSD and GlaxoSmithKline. The authors have no other financial or non-financial competing interests. Author contributions: Substantial contribution to the conception and design of the work: all authors. 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J Gen Intern Med 38:195–202. https://doi.org/10.1007/s11606-022-07699-8 Creed F (2022) The Predictors of Somatic Symptoms in a Population Sample: The Lifelines Cohort Study. Psychosom Med 84:1056–1066. https://doi.org/10.1097/PSY.0000000000001101 Additional Declarations Competing interest reported. Competing interests: Heikki O Koskela has received funding for the present study from Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö Foundations, payments for lectures from Boehringer Ingelheim and MSD, and owns shares of a medical company Orion. Johanna T Kaulamo has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, Suomen Tuberkuloosin vastustamisyhdistyksen Säätiö, Väinö ja Laina Kiven Säätiö, and Suomen Kulttuurirahasto foundations, and travel support from Boehringer-Ingelheim for attending a scientific meeting. Anne M Lätti has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, KYS:n Tutkimussäätiö, Suomen Tuberkuloosin Vastustamisyhdistyksen Säätiö, and Väinö ja Laina Kiven Säätiö Foundations, travel support from Orion, Boehringer Ingelheim and Roche for attending a scientific meeting, and payment for lectures and Advisory Board participations from Farmasian oppimiskeskus, MSD and GlaxoSmithKline. The authors have no other financial or non-financial competing interests. Cite Share Download PDF Status: Published Journal Publication published 29 Nov, 2024 Read the published version in Lung → Version 1 posted Editorial decision: Revision requested 22 Sep, 2024 Reviews received at journal 13 Aug, 2024 Reviewers agreed at journal 25 Jul, 2024 Reviewers invited by journal 20 Jul, 2024 Editor assigned by journal 16 Jul, 2024 Submission checks completed at journal 16 Jul, 2024 First submitted to journal 16 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4749602","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":335877526,"identity":"b839cb4b-0e27-4e26-a70e-99bc06bf6f50","order_by":0,"name":"Heikki O Koskela","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIie3RMWrDMBTG8U8Y7NGrM/QOMoaUgulZ9DB47gE6OAjcJdSrcwvfoDYBeSn1GsgQlV7AU8kQQhQSSiclkCWD/stDww89IcDlusM4mGQFNxM+oJECXotRXE0EcjMFq+0EHivwR5YnYlvsMZAyrl+QhKEiLV4HqnywQlvI07yT1HBMJ3W+5EKtaVEaYl1sRbLTHClfBWUk/DU1myLQVrL5PpOhf9uK/Rd9qIu3sNNivM0VqGyp8S+RTzLP51Fi3pJF9J4ltWIzO+n7n8l8l8ZVqOJx/H1+qEqvm20t5Fz0/3D8J5fL5XLd1AH2m1TJOS8yEQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Eastern Finland","correspondingAuthor":true,"prefix":"","firstName":"Heikki","middleName":"O","lastName":"Koskela","suffix":""},{"id":335877529,"identity":"0ad0e0e9-ae1e-4e24-b70d-d7d50875be26","order_by":1,"name":"Johanna T Kaulamo","email":"","orcid":"","institution":"University of Eastern Finland","correspondingAuthor":false,"prefix":"","firstName":"Johanna","middleName":"T","lastName":"Kaulamo","suffix":""},{"id":335877532,"identity":"43074543-fd53-4522-81e7-be85c106e171","order_by":2,"name":"Anne M Lätti","email":"","orcid":"","institution":"Kuopio University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Anne","middleName":"M","lastName":"Lätti","suffix":""}],"badges":[],"createdAt":"2024-07-16 12:12:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4749602/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4749602/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00408-024-00763-6","type":"published","date":"2024-11-29T15:57:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62052186,"identity":"ad3fe23a-6bdf-46bd-9935-058b72e0fc74","added_by":"auto","created_at":"2024-08-08 17:58:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":410491,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Fig1withheading.png","url":"https://assets-eu.researchsquare.com/files/rs-4749602/v1/64baa7bd8cc4643b980add07.png"},{"id":62051891,"identity":"9ae8d361-f9d3-4189-8d05-1439b409d324","added_by":"auto","created_at":"2024-08-08 17:50:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":198937,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure2withheading.png","url":"https://assets-eu.researchsquare.com/files/rs-4749602/v1/b3da05a0364ca8e95071dd7f.png"},{"id":62051890,"identity":"d89abd68-fd47-4777-ab93-9efd5ef1bfeb","added_by":"auto","created_at":"2024-08-08 17:50:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":212329,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure3withheading.png","url":"https://assets-eu.researchsquare.com/files/rs-4749602/v1/a1f52f19419c745e33ceaf66.png"},{"id":70382023,"identity":"56b4b897-18ed-4f1d-9755-338949fe4a63","added_by":"auto","created_at":"2024-12-02 16:21:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1354911,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4749602/v1/3d889642-0a12-46da-8d17-770bf16769e7.pdf"}],"financialInterests":"Competing interest reported. Competing interests: Heikki O Koskela has received funding for the present study from Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö Foundations, payments for lectures from Boehringer Ingelheim and MSD, and owns shares of a medical company Orion. Johanna T Kaulamo has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, Suomen Tuberkuloosin vastustamisyhdistyksen Säätiö, Väinö ja Laina Kiven Säätiö, and Suomen Kulttuurirahasto foundations, and travel support from Boehringer-Ingelheim for attending a scientific meeting. Anne M Lätti has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, KYS:n Tutkimussäätiö, Suomen Tuberkuloosin Vastustamisyhdistyksen Säätiö, and Väinö ja Laina Kiven Säätiö Foundations, travel support from Orion, Boehringer Ingelheim and Roche for attending a scientific meeting, and payment for lectures and Advisory Board participations from Farmasian oppimiskeskus, MSD and GlaxoSmithKline. The authors have no other financial or non-financial competing interests.","formattedTitle":"The associations of long-term temperature and precipitation with chronic respiratory symptoms: Projections for the changing climate","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe temperatures are rising globally, accompanied by changes in precipitation patterns [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The speed of global warming is especially rapid in the arctic area, including Northern America and Northern Europe. This is accompanied with an increase in precipitation, especially during the wintertime [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Respiratory symptoms constitute a large proportion of reasons why people seek medical attention [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, any effect of the climate change on their prevalence is a fundamental health policy issue. It has been widely recognized that more research is needed to assess the burden of climate change on respiratory diseases that may be translated into public health policies. Previous studies about climate and respiratory symptoms often focus on extreme, short-term climatic conditions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Less is known about the effect of long-term changes in climate on chronic respiratory symptoms.\u003c/p\u003e \u003cp\u003eFinland is a culturally homogeneous country situated in Northern Europe, where the change in climate is rapid [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The country is long in the north-south direction with considerable within-country climatic differences. The most southern part of Finland has hemiboreal climate whereas a large area in the north has hemiarctic climate [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. For these reasons, it is a suitable area to investigate the associations between chronic respiratory symptoms and climatic indices. In the present study, we focused on four symptoms that could be clearly defined according to the current literature. We included the long-term average temperature and precipitation in the subjects\u0026rsquo; home municipality in the multivariate models about the risk of these symptoms. Finally, we estimated the effect of the anticipated change in the temperature and precipitation on the risk of the symptoms.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe target population\u003c/h2\u003e \u003cp\u003eThis cross-sectional email survey was originally conducted to estimate the prevalence, risk factors and consequences of chronic cough in elderly subjects [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It was directed to the members of the Finnish Pensioners` Federation (26 205 members with an email address, mean age 72.7 years, 63.5% female). The subjects were sent an information letter, invitation, and the questionnaire in April 2021. A reminder message was sent 2 weeks later. The data was collected electronically. A filled questionnaire was considered as an informed consent.\u003c/p\u003e \u003cp\u003e The study follows the World Medical Association's Declaration of Helsinki and was approved by the Ethics Committee of Kuopio University Hospital (289/2015). The Finnish Pensioners` Federation permitted the conduct of this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire\u003c/h2\u003e \u003cp\u003eAll subjects answered 62 questions about age, socioeconomic status, smoking, lifestyle, recently experienced symptoms, general health, disorders diagnosed by a doctor, medication, healthcare use within the past year, and symptom sum. It was calculated by summing up the following non-respiratory, non-mental symptoms in the past month: Chest pain on exertion, aching joints, back pain, sciatica (back pain that radiates to the leg), toothache, swollen feet, headache, constipation, other gut problems (flatulence, diarrhea), and urinary problems. Ever smoking was defined as daily smoking for more than one year ever in lifetime. The subjects were asked whether there was moisture damage identified in their home during the past 12 months. They were also asked about their current home municipality and region.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDefinitions of the respiratory symptoms\u003c/h2\u003e \u003cp\u003eChronic rhinosinusitis was present if there was either nasal blockage or discharge, and either reduction/loss of smell or facial pain/pressure for \u0026ge;\u0026thinsp;3 months within the past year [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Chronic cough was defined as current cough which had lasted\u0026thinsp;\u0026gt;\u0026thinsp;8 weeks [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Wheezing with dyspnea was defined as positive answers to both of the following questions: \u0026ldquo;In the past year (12 months), have you experienced wheezing or a whistling sound when you breathe\u0026ldquo; and \u0026ldquo;Have you experienced a shortness of breath at the same time when your breathing is wheezy or whistling\u0026rdquo; [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Sleep apnea was defined as presence of \u0026ge;\u0026thinsp;2 of the following features: Loud snoring, daytime tiredness, observed apneas and arterial hypertension (the STOP-questionnaire) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eInformation about the home municipality and the home region\u003c/h2\u003e \u003cp\u003eThe mainland Finland consists of 18 regions, which are divided to municipalities, 293 altogether. For each home region and municipality, the mean annual precipitation, mean winter (November - April) precipitation, mean summer (May - October) precipitation, mean annual temperature, mean winter temperature, and mean summer temperature for the years 2000\u0026ndash;2021 were kindly provided by the Finnish Meteorological Institute. In addition, each municipality was classified as urban, semi-urban, or rural, according to the classification by the Statistics Finland [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe relative prevalence of the respiratory symptoms in each region was calculated as the prevalence in the region divided by the mean prevalence in Finland. Two small regions (Ostrobothnia and Central Ostrobothnia) were combined to achieve at least 100 responders for each region.\u003c/p\u003e \u003cp\u003eThe associations of the respiratory symptoms with the climatic indices in the home municipality were assessed utilizing bivariate and multivariate logistic regression analyses with a backward directed stepwise procedure. The annual precipitation was expressed as hundreds of mm. In the multivariate models, the following covariates were included: Age, body mass index, gender, ever smoking daily at least one year, family incomes, the classification of the municipality, and symptom sum.\u003c/p\u003e \u003cp\u003eSPSS software version 29.0.1.0 (IBM SPSS Statistics for Windows) was utilized and a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. The descriptive data is expressed as percentages or means and 95% confidence intervals (CI) and the risks as odds ratios (OR) and CIs.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe response rate was 23.6% (n\u0026thinsp;=\u0026thinsp;6189, Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) representing all regions and 282 municipalities. The proportion of missing values was \u0026lt;\u0026thinsp;2.5%, except for the question about family income (2.9%) and the sleep apnea-related questions (3.1\u0026ndash;3.7%). The home municipality and region could not be assessed for 34 subjects (0.5%). 88 subjects (1.4%) reported about moisture damage in their home during the past 12 months.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe basic characteristics of the 6189 responders. The figures are means and 95% confidence intervals or percentages. The numbering of the regions corresponds to the official numbering in Finland and those in the maps.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.2 (72.08\u0026ndash;72.35)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale gender (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.4 (27.3\u0026ndash;27.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYearly family incomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eless than 15 000 e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15 000\u0026ndash;40 000 e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40 000\u0026ndash;70 000 e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70 000\u0026ndash;120 000 e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 120 000 e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of current home municipality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSemi-urban (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smokers (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver smokers (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjects with chronic rhinosinusitis (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjects with current chronic cough (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjects with wheezing and dyspnea during the last 12 months (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjects with sleep apnea (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent home region (the numbers on the maps)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUusimaa (1) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthwest Finland (2) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatakunta (4) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKanta-H\u0026auml;me (5) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePirkanmaa (6) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u0026auml;ij\u0026auml;t-H\u0026auml;me (7) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKymenlaakso (8) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Karelia (9) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Savo (10) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth Savo (11) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth Karelia (12) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral Finland (13) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Ostrobothnia (14) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOstrobothnia and Central Ostrobothnia joined (16) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth Ostrobothnia (17) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKainuu (18) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLapland (19) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eChronic rhinosinusitis and chronic cough were most prevalent in the south-eastern regions (Fig.\u0026nbsp;1a, b). Wheezing with dyspnea and sleep apnea showed no clear regional patterns (data not shown). The long-term winter precipitation was highest in the south-eastern regions (Fig.\u0026nbsp;2) whereas the long-term temperatures were highest in the south-western regions (Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eIn the bivariate and multivariate logistic regression analyses, chronic rhinosinusitis and chronic cough were statistically significantly associated with the mean annual precipitation in the home municipality and especially, with the mean winter precipitation (Tables \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In addition, chronic cough showed a weak association with summer temperature. Wheezing with dyspnea and sleep apnea were not associated with the climatic indices.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe bivariate associations between the respiratory symptoms and the mean climatic conditions during the years 2000\u0026ndash;2021 in the current home municipality. The figures represent odds ratios calculated by logistic regression analyses.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClimatic indices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic\u003c/p\u003e \u003cp\u003erhinosinusitis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChronic cough\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWheezing with dyspnea\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSleep apnea\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYearly precipitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.58 (1.26\u0026ndash;1.98)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.34 (1.10\u0026ndash;1.62)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.15 (0.91\u0026ndash;1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98 (0.85\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWinter precipitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.93 (1.40\u0026ndash;2.65)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.63 (1.24\u0026ndash;2.14)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.13 (0.81\u0026ndash;1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98 (0.80\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSummer precipitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.64 (1.07\u0026ndash;2.53)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.20 (0.83\u0026ndash;1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.35 (0.86\u0026ndash;2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96 (0.72\u0026ndash;1.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYearly temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.03 (0.97\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.06 (1.00-1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98 (0.91\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.99 (0.95\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWinter temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.97\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.04 (0.99\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.97 (0.93\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.99 (0.96\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSummer temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.08 (0.98\u0026ndash;1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.10 (1.02\u0026ndash;1.20)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.99 (0.90\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98 (0.93\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe ORs for the precipitation are calculated per 100 mm, the ORs for the temperatures per one \u003csup\u003eo\u003c/sup\u003eC.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe multivariate associations between the respiratory symptoms and the mean climatic conditions during the years 2000\u0026ndash;2021 in the current home municipality. The following covariates were included: Age, body mass index, gender, ever smoking daily at least one year, family incomes, the classification of the municipality, and symptom sum. The figures represent adjusted odds ratios calculated by logistic regression analyses.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClimatic indices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic\u003c/p\u003e \u003cp\u003erhinosinusitis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChronic cough\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWheezing with dyspnea\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSleep apnea\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYearly precipitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.53 (1.21\u0026ndash;1.93)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.32 (1.09\u0026ndash;1.60)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.11 (0.87\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00 (0.85\u0026ndash;1.16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWinter precipitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.79 (1.29\u0026ndash;2.49)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.57 (1.19\u0026ndash;2.07)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.06 (0.75\u0026ndash;1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.97 (0.78\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSummer precipitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.67 (1.07\u0026ndash;2.61)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.28 (0.87\u0026ndash;1.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.37 (0.85\u0026ndash;2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.05 (0.77\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYearly temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.03 (0.96\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.05 (0.99\u0026ndash;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.97 (0.90\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.97 (0.93\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWinter temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.01 (0.96\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.02 (0.98\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.97 (0.92\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98 (0.95\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSummer temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.07 (0.97\u0026ndash;1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.09 (1.01\u0026ndash;1.18)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98 (0.89\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96 (0.90\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe ORs for the precipitation are calculated per 100 mm, the ORs for the temperatures per one \u003csup\u003eo\u003c/sup\u003eC.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study among elderly Finnish subjects, chronic rhinosinusitis and chronic cough were associated with the long-term mean winter precipitation in the home municipality, whereas wheezing with dyspnea and sleep apnea were not associated with any climatic indices. The results suggest different contributions of climate on different chronic respiratory symptoms.\u003c/p\u003e \u003cp\u003ePrevious studies about climate and respiratory symptoms often focus on extreme, short-term climatic conditions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A large survey in 32 countries showed that in humid, subtropical regions, anomalously wet conditions increase the risk of cough [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A Japanese study found the mean vapor pressure to be the most important environmental factor associated with acute exacerbation of nonallergic rhinitis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our findings suggest that even mild, but long-lasting or repetitive high precipitation may increase the risks of chronic rhinosinusitis and chronic cough.\u003c/p\u003e \u003cp\u003eIn Nordic countries like Finland, much of the winter precipitation comes in the form of snow. Thus, a large proportion of water is in a solid state until spring, when it melts during a relative short period in March-April. At that stage, a large amount of water is released. This may be regarded as minor flooding, though it is a normal annual phenomenon. These minor annual floods may be, at least partly, responsible for the associations of chronic rhinosinusitis and chronic cough with high winter precipitation. Of note, the present survey was performed in April, in the middle of the melting period. This may have affected the results.\u003c/p\u003e \u003cp\u003eThe association of high winter precipitation with the risks of chronic rhinosinusitis and chronic cough may mediate via an increase in the indoors humidity. People spend most of their time indoors and indoors absolute humidity correlates well with the outdoors absolute humidity throughout the year [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. High indoors humidity is well known to associate with cough and nasal symptoms. Under such conditions, the building occupants may be exposed to increased levels of microbial agents such as fungal spores, formaldehyde from building materials, as well as odors, microparticles and vapors [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, just 1.4% of the subjects in the present survey reported about moisture damage in their home. Due to the low prevalence of moisture damage, its regional distribution could not be assessed in the present study.\u003c/p\u003e \u003cp\u003eAnother explanation for the association between high precipitation and respiratory symptoms is that high precipitation may increase the pollen concentrations. The association between precipitation and the pollen load is complex. Rainfall during the flowering season decreases the pollen load whereas high precipitation during months preceding the pollination may increase it [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Winter precipitation probably precedes pollination and therefore, high winter precipitation could intensify the pollination. Unfortunately, we did not have information about local pollen counts for the present study, which can be regarded as a weakness.\u003c/p\u003e \u003cp\u003eIt may be plausible to assume that the direct or indirect effects of excessive ambient moisture on respiratory symptoms mediate by altering the function of the airway epithelium. Chronic rhinosinusitis, chronic cough, and wheezing with dyspnea all may involve a dysfunctional airway epithelial barrier [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Therefore, it is interesting that only chronic rhinosinusitis and chronic cough were associated with high winter precipitation. We suggest three possible explanations. Firstly, the nose plays a primary role within the airways, working as a filter and air-conditioner [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Thus, it is probable that the effects of high indoors humidity or high pollen load affects more the nose than the lower airways [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Secondly, chronic rhinosinusitis is a well-known cause for chronic cough [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Thirdly, wheezing with dyspnea is typical for asthma, which is a very strongly genetically determined disorder [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Thus, environmental factors may play a minor role.\u003c/p\u003e \u003cp\u003eThe recently updated climate change scenarios indicate that the winter precipitation may increase up to 40% during the current century in Finland, indicating almost 100 mm increase [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Our multivariate model suggest that this could increase the risk of chronic rhinosinusitis by 79% and the risk of chronic cough by 57%. These are alarming figures given the high prevalence and the high health resource utilization due to these symptoms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, projections to the future are complicated and our results should be interpreted with caution. For example, despite the increasing winter precipitation, the snow cover tends to get thinner in the Northern Hemisphere due to warming of the winters [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This probably decreases the amounts of water released during the melting period in spring. In addition, climate change probably leads to many other environmental phenomena. These include the intensification of pollen and other bioallergenic proteins production, including bacteria, viruses, animal dander, insects, molds, and plant species. Furthermore, climate change may also influence the ambient concentrations of air pollutants including carbon monoxide, lead, nitrogen dioxide, ozone, particulate matter, and sulfur dioxide. These variables could not be taken into account in the present study but are a capable to affect, and probably increase further, the risks of chronic rhinosinusitis and chronic cough in the future [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present cross-sectional survey can only reveal associations, not causal relationships. Other weaknesses of the study include the limited generalizability of the results: They may only apply to countries with cool climate and an increase in precipitation due to climate change. In many other areas of the word, the climate change probably decreases precipitation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the present study, the associations between long-term temperatures and respiratory symptoms were weak or absent. This may be since people spend most of their time indoors and that in cool climates like that in Finland, indoors temperatures are kept rather stable throughout the year. In areas with warmer climate, the situation is different and the indoors air temperatures correlate better with the outdoors temperature [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Furthermore, the present population was old, and the results may not be directly applicable to younger subjects. The participation rate was low, but the age and gender distribution of the responders closely resembled that of the target population.\u003c/p\u003e \u003cp\u003eThe main strength of the present study is the accurate information about the long-term mean temperatures and precipitations in each subjects\u0026rsquo; home municipality. The respiratory symptoms were strictly defined as currently suggested in the literature. Furthermore, many factors that could affect the risk of respiratory symptoms could be considered in the multivariate analyses: Smoking, socio-economical state, urban versus rural municipality, and the individual differences in experiencing and reporting of bodily sensations, which was covered by the variable \u0026lsquo;symptom sum\u0026rsquo; [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, chronic rhinosinusitis and chronic cough showed strong associations with long-term winter precipitation in the home municipality. Given the anticipated rapid increase in winter precipitation in Northern America and Northern Europe due to climate change, these symptoms may become more prevalent and present an increasing burden on primary health care. However, more reliable projections for the future would require more comprehensive information about other climate change-associated phenomena.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements: The authors thank Seppo Hartikainen from Istekki Ltd for the assistance in modifying the electronic questionnaire, Kirsti Jylhä and Ville Siiskonen from the Finnish Meteorological Institute for the climatic data and for the help to interpret this data.\u003c/p\u003e\n\u003cp\u003eFunding: This study was supported by Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö foundations. They had no role in the planning or analysis of present study.\u003c/p\u003e\n\u003cp\u003eCompeting interests: Heikki O Koskela has received funding for the present study from Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö Foundations, payments for lectures from Boehringer Ingelheim and MSD, and owns shares of a medical company Orion. Johanna T Kaulamo has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, Suomen Tuberkuloosin vastustamisyhdistyksen Säätiö, Väinö ja Laina Kiven Säätiö, and Suomen Kulttuurirahasto foundations, and travel support from Boehringer-Ingelheim for attending a scientific meeting. Anne M Lätti has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, KYS:n Tutkimussäätiö, Suomen Tuberkuloosin Vastustamisyhdistyksen Säätiö, and Väinö ja Laina Kiven Säätiö Foundations, travel support from Orion, Boehringer Ingelheim and Roche for attending a scientific meeting, and payment for lectures and Advisory Board participations from Farmasian oppimiskeskus, MSD and GlaxoSmithKline. The authors have no other financial or non-financial competing interests.\u003c/p\u003e\n\u003cp\u003eAuthor contributions: Substantial contribution to the conception and design of the work: all authors. Acquisition, analysis, or interpretation of data for the work: all authors. Drafting the article or revising it critically for important intellectual content: all authors. Agreement to be accountable for all aspects of the work, in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved: all authors.\u003c/p\u003e\n\u003cp\u003eEthics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Kuopio University Hospital (289/2015)\u003c/p\u003e\n\u003cp\u003eConsent to participate: The decision to respond to the questionnaire was considered as an informed consent.\u003c/p\u003e\n\u003cp\u003eConsent to publish: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLehtonen I, Jylh\u0026auml; K (2019) Tendency towards a more extreme precipitation climate in the Coupled Model Intercomparison Project Phase 5 models. 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Psychosom Med 84:1056\u0026ndash;1066. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/PSY.0000000000001101\u003c/span\u003e\u003cspan address=\"10.1097/PSY.0000000000001101\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"lung","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lung","sideBox":"Learn more about [Lung](https://www.springer.com/journal/408)","snPcode":"408","submissionUrl":"https://submission.nature.com/new-submission/408/3","title":"Lung","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"cough, chronic cough, asthma, wheezing, rhinitis, chronic rhinosinusitis, sleep apnea, climate, climate change","lastPublishedDoi":"10.21203/rs.3.rs-4749602/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4749602/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo clarify the associations of climatic indices with chronic respiratory symptoms, with a final aim to approximate the effects of climate change on them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn e-mail survey was directed to the members of the Finnish Pensioners` Federation. The mean 20-years’ precipitation and temperature in each subjects’ home municipality were obtained from the Finnish Meteorological Institute, separately for summer and winter. Adjusted multivariate models were utilized to investigate the associations of the climatic indices with chronic rhinosinusitis, chronic cough, wheezing with dyspnea, and sleep apnea.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were 6189 responders from 283 municipalities. Chronic rhinosinusitis and chronic cough were most prevalent in the southeastern regions of the country, where the precipitation counts were highest. In the multivariate models, winter precipitation in the home municipality increased the risks of chronic rhinosinusitis and chronic cough (adjusted OR 1.79 (1.29-2.49) per 100 mm, p \u0026lt; 0.001, and 1.57 (1.19 to 2.07), p = 0.001, respectively). Wheezing with dyspnea and sleep apnea were not associated with the climatic indices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChronic rhinosinusitis and chronic cough were associated with long-term winter precipitation. Given the anticipated increase in winter precipitation in Northern America and Northern Europe, the prevalences of chronic rhinosinusitis and chronic cough may increase there.\u003c/p\u003e","manuscriptTitle":"The associations of long-term temperature and precipitation with chronic respiratory symptoms: Projections for the changing climate","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-08 17:50:53","doi":"10.21203/rs.3.rs-4749602/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-22T16:03:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-13T14:24:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106174207572790078772594424549680445379","date":"2024-07-25T13:59:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-20T11:57:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-16T14:15:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-16T14:14:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Lung","date":"2024-07-16T12:10:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"lung","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lung","sideBox":"Learn more about [Lung](https://www.springer.com/journal/408)","snPcode":"408","submissionUrl":"https://submission.nature.com/new-submission/408/3","title":"Lung","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"494920b0-fc3c-40bf-ba87-45193cd94509","owner":[],"postedDate":"August 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-02T16:00:15+00:00","versionOfRecord":{"articleIdentity":"rs-4749602","link":"https://doi.org/10.1007/s00408-024-00763-6","journal":{"identity":"lung","isVorOnly":false,"title":"Lung"},"publishedOn":"2024-11-29 15:57:11","publishedOnDateReadable":"November 29th, 2024"},"versionCreatedAt":"2024-08-08 17:50:53","video":"","vorDoi":"10.1007/s00408-024-00763-6","vorDoiUrl":"https://doi.org/10.1007/s00408-024-00763-6","workflowStages":[]},"version":"v1","identity":"rs-4749602","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4749602","identity":"rs-4749602","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}