Evaluation and Control of Allergic Rhinitis in Adult Patients with Asthma (CARINA) in Korea

Abstract

Background: Allergic rhinitis (AR) is the most common comorbid condition in bronchial asthma (BA), which is associated with increased morbidity and difficulty in asthma control. Recent guidelines have emphasized an integrated approach in the management of patients with both BA and AR. Objectives : This study evaluated the prevalence of AR in patients with BA and evaluated its impact on asthma. Methods: Adult patients with BA who visited outpatient clinics of general hospitals and primary clinics for asthma management were enrolled sequentially between October 2005 and March 2006. The prevalence and symptom scores of AR and BA were assessed using an ISAAC questionnaire. The severity of BA and AR was classified according to the GINA and ARIA guidelines, respectively. Results: A total of 460 patients with BA were recruited from two university hospitals (n=109) and 49 primary care units (n=351). The prevalence of AR symptoms was 72.6% (334/460). Although the prevalence was higher in younger patients, AR symptoms were also prevalent in elderly patients (59.1% in patients aged > or = 65 years). Of the 334 patients with concomitant BA and AR symptoms, 59 (17.7%) were not diagnosed with AR, even though the patients reported AR symptoms. The cure-rate of AR in patients with both BA and AR was 65.3% (218/334). The most common level for AR severity was mild intermittent (38.3%) followed by moderate-severe intermittent (26.6%), mild persistent (24.3%) and moderate-severe persistent (10.8%). The prevalence of AR was not different according to the asthma severity. The patients experienced AR symptoms more frequently in November, followed by October, March and April. The BA patients combined with AR tended to present higher asthma symptom sores and suffered from significantly higher night symptoms than those with BA alone (P<0.05). Conclusion: The prevalence of AR was 73% in adult asthma patients; however, AR has been underdiagnosed and undermanaged. AR should be evaluated and managed properly in all asthmatic patients to achieve a better asthma control.