Caribbean Latinx with moderate-severe asthma bear greater asthma morbidity than other Latinx.

BACKGROUND: Hispanic/Latinx (HL) ethnicity encompasses racially and culturally diverse subgroups. Studies suggest that Puerto Ricans (PR) may bear greater asthma-related morbidity than Mexicans, but these were conducted in children or had limited clinical characterization. OBJECTIVES: This study sought to determine whether disparities in asthma morbidity exist among HL adult subgroups. METHODS: Adults with moderate-severe asthma were recruited from US clinics, including from Puerto Rico, for the Person Empowered Asthma Relief (PREPARE) trial. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans [C&D]), the investigators compared baseline self-reported clinical characteristics between Caribbean HL (CHL) (PR and C&D: n = 457) and other HLs (OHL) (Mexicans, Spaniards, Central/South Americans; n = 141), and between CHL subgroups (C&D [n = 56] and PR [n = 401]). This study compared asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids, emergency department/urgent care (ED/UC) visits, hospitalizations, health care utilization) through negative binomial regression. RESULTS: CHL compared to OHL were similar in age, body mass index, poverty status, blood eosinophils, and fractional exhaled nitric oxide but were prescribed more asthma controller therapies. Relative to OHL, CHL had significantly increased odds of asthma exacerbations (odds ratio [OR]: 1.84; 95% CI: 1.4-2.4), ED/UC visits (OR: 1.88; 95% CI: 1.4-2.5), hospitalization (OR: 1.98; 95% CI: 1.06-3.7), and health care utilization (OR: 1.91; 95% CI: 1.44-2.53). Of the CHL subgroups, PR had significantly increased odds of asthma exacerbations, ED/UC visits, hospitalizations, and health care utilization compared to OHL, whereas C&D only had increased odds of exacerbations compared to OHL. PR compared to C&D had greater odds of ED/UC and health care utilization. CONCLUSIONS: CHL adults, compared with OHL, adults reported nearly twice the asthma morbidity; these differences are primarily driven by PR. Novel interventions are needed to reduce morbidity in this highly impacted population.

Cannabis attitudes and patterns of use among followers of the Allergy & Asthma Network.

BACKGROUND: Cannabis use in patients with allergy/asthma, a high-risk group for adverse effects to cannabis, is unknown. OBJECTIVE: To determine the patterns of use and attitudes toward cannabis in patients with allergy/asthma. METHODS: An anonymous online survey on cannabis attitudes and use was conducted through the Adult Allergy & Asthma Network. The Asthma Control Test assessed asthma burden. Cluster analyses determined group phenotypes and factor analyses condensed cannabis subjective effects into similar response patterns. RESULTS: A total of 88 of 489 respondents (18.0%) currently use cannabis with most at the age of less than 50 years old, of female sex, and of White race. Of the noncannabis users (N = 401), 2.5% reported cannabis allergy. Cluster analysis revealed that a liberal attitude toward cannabis was associated with current cannabis use (P < .001). Among current cannabis users, 40.9% of their physicians inquired on cannabis use; only 37.5% of users wanted to discuss cannabis. In addition, 65.9% used cannabis for medical or medical/recreational purposes. Cannabinoids used were tetrahydrocannabinol (33.0%), cannabidiol (19.3%), or both (47.7%). Smoked and vaped cannabis were reported by 53.4% and 35.2%, respectively. Furthermore, 51 cannabis users (58.0%) reported current asthma with 39.2% uncontrolled; of these, 50% smoked cannabis. Compared with current participants with asthma not using cannabis, those currently using cannabis experienced similar levels of asthma control, quality of life, and frequency of asthma exacerbations. Positive effects were endorsed more than negative effects to cannabis (P < .001). Moreover, 19.3% of cannabis users reported coughing that was associated with smoking cannabis (P < .001). CONCLUSION: Cannabis was used by less than 20% of the respondents with positive effects more frequent than negative effects. Half of cannabis users with uncontrolled asthma smoke cannabis, but only a minority of the physicians inquire about its use.

Usefulness of harmonica playing to improve outcomes in patients with chronic obstructive pulmonary disease.

Pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) includes a multidisciplinary approach of exercise and pursed-lip diaphragmatic breathing. Pursed-lip diaphragmatic breathing reduces alveolar collapse during exhalation, and diaphragmatic breathing improves inspiratory pressures. Harmonica playing has maneuvers similar to those taught in pursed-lip diaphragmatic breathing, with diaphragmatic breathing to create musical tones. Hence, we designed a trial to determine whether patients with COPD would benefit from harmonica playing. COPD patients who completed pulmonary rehabilitation at least 6 months prior were eligible for this trial. Patients attended 12 weeks of harmonica training sessions for 2 hours a week and were encouraged to practice at home. Participants completed pre- and postspirometry testing, maximum inspired and expired pressure (PImax, PEmax) testing, and 6-minute walk tests. Eleven of the 14 participants completed the 12-week trial. PImax and PEmax increased by an average of 15.4 ± 12.0 cm H2O (P = 0.0017) and 14.4 ± 14.0 cm H2O (P = 0.0061), respectively. Additionally, 6-minute walk distance increased by approximately 60 m (61 ± 78, P = 0.03). This pilot study showed that a 12-week harmonica program significantly improved PImax, PEmax, and 6-minute walk distance in COPD patients after rehabilitation. Larger-scale harmonica studies are warranted to evaluate this program's adjunctive potential benefit to formal pulmonary rehabilitation.

Approaches to chronic disease management for asthma and chronic obstructive pulmonary disease: strategies through the continuum of care.

Investigator-initiated research in both asthma and chronic obstructive pulmonary disease conducted at the Baylor Martha Foster Lung Care Center has sought to improve management throughout the continuum of respiratory care using a multidisciplinary approach. Respiratory care therapists employed in the primary care setting were shown to improve the quality of asthma care: rescue inhaler use decreased by 75% and respiratory symptom score decreased by 49% in patients who were seen by this midlevel specialty provider. In addition to similar results in a geriatric population, patients' diagnosis was changed in 48% of cases and treatment was changed in 76% of cases after the intervention. For pulmonary rehabilitation, an activity of daily living assessment form was created, and rehabilitation-whether traditional or water-based-was shown to improve patients' ability to perform activities of daily living and improve quality of life scores. The Rules of Two((R)), developed by Baylor University Medical Center at Dallas to simplify understanding of good asthma control, continues to be taught, and patient education has also been offered through asthma summer camps for children. Finally, a multidisciplinary team worked to develop a protocol for treatment of asthma patients in the emergency department and, through this effort, was able to reduce length of stay from an average of 278 minutes to an average of 168 minutes. These efforts aim to overcome the gap between recommended care and actual practice, so that patients benefit from evidence-based medicine and continuing refinements to diagnosis and treatment.

Quality of life and physical performance in land- and water-based pulmonary rehabilitation.

PURPOSE: Traditional land-based pulmonary rehabilitation (PR) has been shown to provide improvement in physical performance and quality of life in patients with chronic obstructive pulmonary disease (COPD). The training effects of a water environment in pulmonary patients have only been briefly investigated. The purpose of this retrospective study was to compare quality of life and physical performance in land- and water-based PR. METHODS: The study included participants of a land- or water-based PR program. Twenty land- and water-based participants with stable COPD disease were retrospectively matched within 20 mL of their forced expiratory ventilation in 1 second. A multivariate analysis of variance was performed on each group's 6-minute walk test distance; 6-repetition maximum strength tests for the knee, hip, and shoulder; and mental and physical health summary scores of the Medical Outcomes Short-form 36. RESULTS: Each group significantly improved in all outcome measurements, but there was no difference found in the improvements between the land- or water-based groups. CONCLUSION: Clinicians can consider water-based PR exercise program as another treatment option, if available, for patients with COPD and expect similar benefits to traditional land-based PR programs including improved walk distances, strength, and perception of well-being.

Evolutionary stability of egg trading and parceling in simultaneous hermaphrodites: the chalk bass revisited.

Several species of simultaneously hermaphroditic seabasses living on coral reefs mate by alternating male and female roles with a partner. This is known as egg trading, one of the classic and most widely cited examples of social reciprocity among animals. Some of the egg-trading seabass species, including the chalk bass, Serranus tortugarum, switch mating roles repeatedly, having subdivided their clutch of eggs into parcels offered to the partner for fertilization. Here we attempt to understand these dynamics as a pair of evolutionary games, modifying some previous approaches to better reflect the biological system. We find that the trading of egg clutches is evolutionarily stable via byproduct mutualism and resistant to invasion by rare individuals that take the male role exclusively. We note why and how parceling may reflect sexual conflict between individuals in the mating pair. We estimate evolutionarily stable parcel numbers and show how they depend on parameter values. Typically, two or more sequential parcel numbers are evolutionarily stable, though the lowest of these yields the highest fitness. Assuming that parcel numbers are adjusted to local conditions, we predict that parcel numbers in nature are inversely related both to mating group density (except at low density) and predation risk.

Density-dependent habitat selection and performance by a large mobile reef fish.

Many exploited reef fish are vulnerable to overfishing because they concentrate over hard-bottom patchy habitats. How mobile reef fish use patchy habitat, and the potential consequences on demographic parameters, must be known for spatially explicit population dynamics modeling, for discriminating essential fish habitat (EFH), and for effectively planning conservation measures (e.g., marine protected areas, stock enhancement, and artificial reefs). Gag, Mycteroperca microlepis, is an ecologically and economically important warm-temperate grouper in the southeastern United States, with behavioral and life history traits conducive to large-scale field experiments. The Suwannee Regional Reef System (SRRS) was built of standard habitat units (SHUs) in 1991-1993 to manipulate and control habitat patchiness and intrinsic habitat quality, and thereby test predictions from habitat selection theory. Colonization of the SRRS by gag over the first six years showed significant interactions of SHU size, spacing, and reef age; with trajectories modeled using a quadratic function for closely spaced SHUs (25 m) and a linear model for widely spaced SHUs (225 m), with larger SHUs (16 standardized cubes) accumulating significantly more gag faster than smaller 4-cube SHUs (mean = 72.5 gag/16-cube SHU at 225-m spacing by year 6, compared to 24.2 gag/4-cube SHU for same spacing and reef age). Residency times (mean = 9.8 mo), indicative of choice and measured by ultrasonic telemetry (1995-1998), showed significant interaction of SHU size and spacing consistent with colonization trajectories. Average relative weight (W(r)) and incremental growth were greater on smaller than larger SHUs (mean W(r) = 104.2 vs. 97.7; incremental growth differed by 15%), contrary to patterns of abundance and residency. Experimental manipulation of shelter on a subset of SRRS sites (2000-2001) confirmed our hypothesis that shelter limits local densities of gag, which, in turn, regulates their growth and condition. Density-dependent habitat selection for shelter and individual growth dynamics were therefore interdependent ecological processes that help to explain how patchy reef habitat sustains gag production. Moreover, gag selected shelter at the expense of maximizing their growth. Thus, mobile reef fishes could experience density-dependent effects on growth, survival, and/or reproduction (i.e., demographic parameters) despite reduced stock sizes as a consequence of fishing.

Histamine metabolism in the visual system of the horseshoe crab Limulus polyphemus.

There is now strong evidence that arthropod photoreceptors use histamine as a neurotransmitter. The synthesis, storage and release of histamine from arthropod photoreceptors have been demonstrated, and the postsynaptic effects of histamine and the endogenous neurotransmitter are similar. However, a full understanding of these photoreceptor synapses also requires knowledge of histamine inactivation and metabolism. Relatively little is known about histamine metabolism in the nervous system of arthropods, and mechanisms appear to differ with the species. This study focuses on histamine metabolism in visual tissues of the horseshoe crab Limulus polyphemus, a chelicerate. We present two major findings: (1) histamine is metabolized to imidazole acetic acid and to gamma-glutamyl histamine. (2) relatively low levels of histamine metabolites accumulate in Limulus visual tissues.