Specialized asthma care units (SACUs) improve outcomes in severe asthma by standardizing assessment, enabling phenotyping, and providing access to advanced therapies,1 yet public awareness remains low, possibly delaying referral and restricting access. Asthma substantially impairs quality of life in Spain, particularly in its severe forms, underscoring the need for timely specialized care.2 We aimed to determine public awareness and perceptions of SACUs among adults in Spain and identify visibility gaps in the patient pathway, in order to inform targeted actions to strengthen recognition, referral, and appropriate use.
We conducted a cross-sectional computer-assisted web interview (CAWI) survey (23–28 July 2024) among adults (≥18 years) residing in Spain (n=3424). Participants were recruited using a stratified sampling framework designed to reflect the adult population by sex and age. This analysis derives from the same nationwide survey previously used to report asthma prevalence and comorbidities in Spain, where the full sampling design and fieldwork quality procedures are described.3 Asthma status and asthma severity were self-reported in the questionnaire, and respondents were classified as without or with asthma; among those reporting asthma, severity was categorized as mild, moderate, severe, or unknown according to participant self-report. The questionnaire addressed SACU awareness, knowledge of the nearest SACU, awareness of services offered by SACUs, previous visits, if any, to a SACU, visit experience/satisfaction, perceived importance, and prioritization of measures to improve access and awareness. Further methodological details on sampling, representativeness, and variable definitions are provided in the Supplementary Methods. Full cross-tabulations are shown in Supplementary Table S1.
Awareness of SACUs was low among respondents both with and without asthma (Fig. 1A), although patients with moderate asthma were slightly more aware than those with mild disease (Supplementary Table S1). Knowledge of the nearest SACU was similarly limited (Fig. 1B), and awareness of specific services was low across the board (Fig. 1C). Comprehensive Evaluation and Diagnosis were the most recognized aspects, while Multidisciplinary Care was the least recognized. Self-reported visits were uncommon overall, although levels were higher among people with asthma (Fig. 1D). Rhinitis was the most common comorbidity among SACU users regardless of asthma status; dermatitis was relatively more common in individuals without asthma, whereas concomitant rhinitis and dermatitis and >2 conditions clustered in those with asthma (Fig. 1E). Reported experience was predominantly positive (Fig. 1F), and perceived importance of SACUs was high overall (Fig. 1G). Respondents prioritized actions to improve awareness and access to training for healthcare professionals/primary care, education in health centers, social media, and school/university programs (Fig. 1H).
Summary of survey results on specialized asthma care units (SACU) in Spain: (A) awareness; (B) knowledge of nearest SACU; (C) awareness of specific services; (D) visits; (E) comorbidities among visitors; (F) experience/satisfaction among users; (G) perceived importance of SACUs, and (H) prioritized measures to improve awareness/access (top 4). (A) Stacked bars show the percentage of respondents answering “Yes/No/Not sure” by asthma status (without asthma vs. with asthma); (B and D) stacked bars show the percentage of respondents answering “Yes/No” by asthma status (without asthma vs. with asthma); (C) stacked bars show the proportion who Know/Heard/Don’t know each service; (E) shows the percentage of users by comorbidity (nasal only, skin only, both, >2) and asthma status (without vs. with asthma), (F, G) show visitors experience and perceived importance, respectively (ranking opinion 1–4); and (H) shows, for the top-ranked measures, the combined proportion ‘Totally necessary’+‘Quite necessary’ (Top-2). Full cross-tabulations are shown in Supplementary Table S1.
Two contextual points may help interpret these patterns and justify further investigation. First, attendance without a prior asthma diagnosis is plausible: patients with allergic comorbidities (e.g., rhinitis) or non-specific respiratory symptoms may be referred before asthma is confirmed, and some individuals may not recognize their condition as “asthma.” Second, referral protocols are heterogeneous or absent across settings, and SACUs often lack formal institutional recognition,4,5 which may limit clear labeling (signage/appointment texts) and consistent patient information. These system-level gaps likely highlight a mismatch between awareness and use, with low awareness and service knowledge contrasting with high perceived value and positive user experience.
In conclusion, public awareness of SACUs in Spain is insufficient, knowledge of their location and services is limited, and comorbidity patterns among users suggest a concentration of T2-linked phenotypes; nevertheless, perceived importance and reported satisfaction among users are positive. Health system action should focus on primary care training and pathway-embedded prompts with targeted patient-facing education, and better institutional recognition and labeling of SACUs, while referrals and utilization should be monitored to evaluate impact.
Ethical considerationsThis study complies with the principles of Spanish Law 14/2007 on Biomedical Research, which does not require approval from an ethics committee for studies involving anonymized surveys where participants cannot be identified. The study was conducted in accordance with the Declaration of Helsinki and all relevant institutional and national guidelines and regulations. All personal data were kept confidential, and survey responses were anonymous. Participants were encouraged to answer honestly, with participation being voluntary and uncompensated.
Artificial intelligence involvementDuring the preparation of this work the authors used ChatGPT in order to improve legibility and language. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article.
Informed consentInformed consent was not required, as this is a study involving anonymized surveys where participants cannot be identified. All personal data were kept confidential, and survey responses were anonymous. Participants were encouraged to answer honestly, with participation being voluntary and uncompensated.
FundingNo specific funding was received for this work. The authors’ relationships with industry are disclosed in the competing interest section.
Authors’ contributionsFJA-G, JGS-C, and FC-M contributed to the conception of the study, study design, interpretation of the data, and coordination of the project. AP-G, MB-A, ARF, and FJGB contributed to study design, data interpretation, and critical clinical review of the manuscript. FJA-G, JGS-C and FC-M drafted the first version of the manuscript, and all authors critically revised the manuscript for important intellectual content, approved the final version for submission, and agreed to be accountable for all aspects of the work.
Conflicts of interestFC-M has received honoraria in the last 3 years as a speaker at meetings sponsored by Adamed, Aflofarm, AstraZeneca, Boehringer Ingelheim, Chiesi, CSL-Behring, FAES, GlaxoSmithKline, Grifols, Menarini, Novartis, Pfizer, Sanofi-Regeneron, VERTEX, and as a consultant for Sanofi, GSK, Grifols and CSL-Behring. He declares not having received, directly or indirectly, funding from the tobacco industry or its subsidiaries. JGS-C has received honoraria in the last 3 years as a speaker at meetings sponsored by AstraZeneca, Sanofi, Menarini, and GSK, and as a consultant for AstraZeneca, Sanofi, GSK, and Chiesi. He has also received financial support for conference attendance from Sanofi and AstraZeneca, and grants for research projects from GSK, Sanofi, and AstraZeneca. MBA has received honoraria in the last 3 years as a speaker at meetings sponsored by Bial, AstraZeneca, Chiesi, GlaxoSmithKline, Sanofi-Regeneron, and VERTEX, and as a consultant for Sanofi, GSK, AstraZeneca. He declares not having received, directly or indirectly, funding from the tobacco industry or its subsidiaries. MARF has received honoraria in the last 2 years as a speaker at meetings sponsored by AstraZeneca, Menarini, GSK, and Chiesi. FJGB has received in the last 3 years honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events; or support for attending meetings and/or travel; or consulting fees or sponsored by Astra-Zeneca, Bial, Chiesi, Gebro Pharma, GlaxoSmithKline, Menarini, Novartis, Sanofi.
Data availabilityThe datasets of the current study are available from the corresponding author on reasonable request.
The authors thank Laia Reverté Calvet and Ánchel González Barriga from Medical Science Consulting (MSC), Valencia, Spain, for providing editorial support in the form of medical writing and assembling tables/figures based on the authors’ detailed directions, collating author comments, copyediting, fact-checking, and referencing.
The followings are the supplementary data to this article:
