Assessment of symptom control and associated factors in patients with asthma and comorbid Allergic Rhinitis in rural and urban areas, in Crete, Greece

Introduction: Limited data exists on Allergic Rhinitis (AR) and asthma control in rural primary care. Therefore, we aimed to assess asthma and AR control in patients attending primary care in both urban and rural settings and to identify potential associated factors. Methods: In this cross-sectional study, asthma patients with AR completed questionnaires assessing demographic, co-morbidities and treatment status. Symptom control was evaluated by Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ) and Control of Allergic Rhinitis/Asthma Test (CARAT). Multivariate logistic regression analysis was applied to identify associated factors of asthma control after adjusting for age, gender, and co-morbidities. Results: Out of 121 subjects with AR and asthma 75 (62%) resided in rural areas. A significant percentage of participants indicated inadequate asthma control using ACT (54%) and ACQ (67%). Moreover, 88% of participants had poorly controlled asthma and AR based on CARAT. Female gender (OR = 5.688, 95% CI 1.056-30.626; p=0.043), living in rural areas (OR = 3.408, 95% CI 0.839-13.841; p=0.046) using systematic inhaled and intranasal corticosteroids (OR = 3.024, 95% CI 0.879-10.407; p=0.039) were associated with controlled asthma and AR based on CARAT. Older age (OR = 0.472, 95% CI 0.196-1.135; p=0.044) and frequent oral corticosteroids use (OR = 0.147, 95% CI 0.017-1.246; p=0.039) were associated with poor asthma control based on ACT. Additionally, patients with two or more AR medications had low odds of reporting-controlled asthma on CARAT (OR = 0.226, 95% CI 0.047-1.086; p=0.043), ACT (OR = 0.454, 95% CI 0.212-0.976; p=0.043) and ACQ (OR = 0.338, 95% CI 0.103-1.101; p=0.042). Discussion: Our results suggest that asthma and AR control remain suboptimal in a large proportion of patients in primary care. Area of residence, demographics, and medications emerged as significant associated factors that must be taken into account in order to effectively improve asthma and AR outcomes.