Original Research
Differences between rural and urban primary care practices in asthma and allergic rhinitis control: the Greek experience
AUTHORS
Eirini Lambraki1 MD
Izolde Bouloukaki1 PhD, General Practitioner, Clinical Researcher *
Nikolaos Tzanakis2 PhD
Alexandros Karatzanis3 PhD, Associate Professor
Ioanna Tsiligianni1 PhD, Associate Professor
AFFILIATIONS
1 Health Planning Unit, Department of Social Medicine, School of Medicine, University of Crete, Crete, Greece
2 Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
3 Department of Otorhinolaryngology, Medical School of Crete University Hospital, Heraklion, Greece
ACCEPTED: 8 July 2025
Early Abstract:
Introduction: Limited data exists on Allergic Rhinitis (AR) and asthma control in rural primary care. Therefore, the aim of our study was to assess asthma and comorbid AR control in patients attending primary care in both urban and rural settings. Additionally, we aimed to identify potential factors associated with the control of asthma and comorbid AR.
Methods: In this cross-sectional study, patients with asthma and comorbid 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 and comorbid AR control after adjusting for age, gender, smoking status and co-morbidities.
Results: Out of 121 subjects with asthma and comorbid AR 75 (62%) resided in rural areas. A significant percentage of participants reported suboptimal asthma control using ACT (54%) and ACQ (67%). Moreover, 88% of participants had poorly controlled asthma and comorbid AR based on CARAT. Females (OR = 4.1, 95% CI 0.8- 19.9; p=0.043), and patients living in rural areas (OR = 3.8 95% CI:1.34-10.5, p=0.010) were more likely to report well controlled asthma and AR based on CARAT score (>24). Patients reporting intranasal steroids (INS) use (OR = 3.6, 95% CI 1.1-121; p=0.035) were more likely to have well controlled asthma based on ACT score. Analysis also indicated a trend toward significance for the association between Short-Acting Beta-Agonist (SABA) use and not-well controlled asthma based on ACT (score≤19) (OR = 5, 95% CI 0.9-10; p=0.066) and partially and not well control asthma based on ACQ (score >0.75) (OR = 5, 95% CI 0.9-10; p=0.066) questionnaires.
Conclusions: 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 comorbid AR outcomes.
Keywords: allergic rhinitis, asthma, asthma control test, asthma control questionnaire, control of allergic rhinitis/asthma test, predictors, primary care, rural urban.