• Federico Montealegre, Domingo Chardon, Wanda Vargas, Manuel Bayona, and Diego Zavala.
• Department of Microbiology, Ponce School of Medicine, Ponce, Puerto Rico. fmontealegre@psm.edu
• Ann. Allergy Asthma Immunol. 2004 Nov 1; 93 (5): 472-7.

BackgroundPuerto Rico has the highest prevalence of asthma in the United States. Currently, there are no data on actual care given to asthmatic patients.ObjectiveTo determine the prevalence of documented adherence to the 1997 National Asthma Education Prevention Program guidelines regarding care given in emergency departments (EDs) in Ponce, Puerto Rico.MethodsA case series was conducted using 6,002 ED records with a physician-based diagnosis of asthma for 1999 through 2001.ResultsA history of asthma attack was documented in 82.0% of the cases and in all age groups. In-home beta-agonist use was recorded in only 5.7% of the medical records. Documentation of previous admissions to the ED and the intensive care unit were found in 3.5% and 0.33% of the records, respectively. Nocturnal symptoms before the ED visit were found in only 6.4% of the records, and asthma treatment at home was found in 39.9%. Accessory muscle retraction was documented in 99.1% of the cases, and oxygen saturation was found in 23.2%. Treatment with nebulized beta-agonist was found in 72.1% of the records, and intravenous or oral corticosteroid use was found in 84.1%. Follow-up appointments were detected in 64.8% of the cases, and referrals to specialists were given in only 5.3%. Rate ratios between our data and those of other researchers indicate that there are geographical differences in compliance with the guidelines.ConclusionOf the variables tested, only one had acceptable levels of compliance, as evidenced in the patient's records, indicating that there are alarming differences in ED evaluation and treatment compared with the 1997 National Asthma Education Prevention Program guidelines.

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