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Ranking the best and worst cities for asthmatics

Editor’s Note: This post was originally the 20 Best Places to Raise a Child With Asthma, but was updated in June 2020 to focus on the 10 Best and Worst Places to Raise a Child With Asthma. These updates were made using newly acquired data from more sources.

Are you concerned about how the city you live in affects you or your child’s asthma symptoms?

Over 25 million Americans live with asthma, but where they live can dramatically affect the severity of symptoms they may deal with on a daily basis. If you or your child is currently dealing with severe symptoms, or you’re worried about developing harsher symptoms later in life — we’ve extensively researched the best and worst places to live with asthma to help you determine if or where you should consider moving to. 

Our list of the 10 best and worst cities to live with asthma is based on research from a 2019 report by the Asthma and Allergy Foundation of America, which examines the top 100 U.S. metropolitan cities and uses a weighted ranking system along with eight risk factors that influence asthma outcomes.

Take a look at our list of the best and worst places to live with asthma along with other important information such as how asthma affects children and how you can help relieve symptoms in your home.


Parents of asthmatic children should be especially concerned about how the place they live affects their child’s asthma severity. Asthma is a long-term lung disease that inflames and narrows airways, making it difficult to breathe. Asthma can be caused by a number of factors that irritate the lungs and it’s also possible to develop asthma as an adult, even if you didn’t have it as a child 

Asthma is especially dangerous to children because of their small lungs. This makes children more sensitive to asthma triggers, which can range from humidity, pollution, pollen, exercise or other irritating particles like mold or smoke.


Places such as a valley, inner-city or heavily forested areas can be asthma aggregators and not ideal places to raise a child with asthma.

Valley areas trap pollutants like smog over cities, creating a barrier that physically stops pollutants from escaping the city ( see graphic below.)

Medium-to-large sized cities are most likely to be heavily polluted due to the excessive population they have and smoke released from multiple cars and trucks on their roads. Cities that don't have smoking laws are even worse, as secondhand smoke is hazardous to children with asthma.

Furthermore, the climate in a city can affect asthma symptoms depending on the type you have. Cold, dry air causes the airways to narrow making it a non-ideal choice for asthmatics triggered by lower temperatures. On the other hand — hot, humid weather makes it easier for airborne particulate matter such as dust and mold to stay in the air longer which is problematic for those with allergic asthma. Lastly, cities with lots of trees and greenery can irritate children who are allergic to pollen and grass.

If you already know these factors are affecting you or your child’s asthma symptoms, consider using an air purifier such as the Alen BreatheSmart FIT50 to help get relief so you can breathe better indoors.


Alen’s list of the best and worst places to raise a child with asthma is based upon data from the Asthma and Allergy Foundation of America’s 2019 Asthma Capitals Report, which analyzed the top 100 U.S. metropolitan cities. The report utilized a weighted ranking system that considers asthma prevalence, asthma-related emergency department visits, and asthma-related deaths. Additionally, the study analyzed the following eight risk factors that can influence asthma outcomes: poverty, lack of health insurance, air quality, pollen count, long-term asthma controller use, quick-relief medicine use, smoke-free laws, and access to asthma specialists. 

Furthermore, the AAFA also communicated with patients, doctors, and legislators to get a better understanding of the impact of having asthma in these cities. Each city is ranked from 1-100 with 1 being the worst city to live with asthma and 100 being the best of the group. It’s important to note that asthma varies from person-to-person, meaning local asthma triggers could cause differences in each individuals’ experience by location.


Worst places to live with asthma

 (Source: AAFA


Take a look at the infographic above to see some of the key factors behind the worst places to live with asthma rankings, or see below to get additional insight for each city.

1. Springfield, MA

Springfield, MA was ranked as the worst place to live with asthma for the second year in a row due to its high number of asthma related emergency room visits, high pollen counts, and high prevalence of asthma overall.

2. Dayton, OH

Dayton, OH holds the second spot on this list as a result of its high asthma rate, indicated by the high usage of quick-relief asthma medicine and controllers.

3. Greensboro, NC

Greensboro, NC stands as the third worst city to live with asthma due to the low number of asthma specialists and a high rate of uninsured citizens, indicating many people aren’t getting proper treatment.

4. Philadelphia, PA

Philadelphia, PA is the fourth city on this list due to a high prevalence of asthma, high number of emergency room visits, and a high number of asthma-related fatalities. The area also has high airborne particle pollution, which makes managing asthma especially difficult. 

5. Cleveland, OH

Cleveland, OH lands at the fifth spot due to its poor air quality, high rate of quick relief medicine use, and the fact that 9% of Cleveland residents have asthma.

6. Allentown, PA

Allentown, PA holds the sixth position on this list due to a high asthma prevalence and a high number of residents affected by pollen in addition to a low number of asthma specialists and few smoking laws. The area also has poor air quality, as indicated by its D ozone pollution score according to the American Lung Association’s 2019 State of Air Report.

7. Louisville, KY

Louisville, KY was ranked as the seventh worst place to live with asthma due to its high pollen count, high controller use, and low air quality. However, the AAFA notes that the city is taking action to improve air quality in order to help asthma sufferers.

8. Boston, MA

Boston, MA is the eighth city on the list as a result of its rate of high asthma prevalence and asthma-related deaths. The city also has a high pollen count which affects those who suffer from allergic asthma.

9. Omaha, NE

Omaha, NE stands as the ninth worst place to live with asthma due to its high number of asthma-related emergency room visits and death rates in addition to a high number of asthma medicine prescriptions.

10. Milwaukee, WI

Milwaukee, WI takes the tenth and final spot for a variety of reasons which include a high number of asthma-related emergency visits, a high poverty rate, and a high rate of asthma controller use.


Best places to live with asthma

(Source: AAFA)


The following cities were at the bottom of the AAFA’s 2019 list, meaning they were the best places to live with asthma of the analyzed cities. As a reminder, local asthma triggers mean each individuals’ experience may vary by location.

1. Cape Coral, FL

Cape Coral, FL takes the top spot as the best place to live with asthma because of it’s low prevalence of asthma and low number of asthma-related emergency room visits. Furthermore, the tropical conditions may actually provide relief for some asthmatics.

2. McAllen, TX

McAllen, TX ranked second because of the city’s low number of asthma-related emergency room visits and asthma-related deaths. Although it should be noted that McAllen, TX also had the report’s highest rate of poverty and it was also rated as the most challenging place to live with spring allergies.

3. Houston, TX

Houston, TX took the third spot and scored exceptionally with a low asthma prevalence, low amount of asthma-related emergency room visits, and a low number of asthma-related deaths. Furthermore, the city even has an Asthma Prevention and Control Program which promotes asthma-friendly policies to help asthmatics, with a special emphasis on helping children.

4. Sarasota, FL

Sarasota, FL holds the fourth spot on the list due to its low prevalence of asthma, but it’s also notable for the area’s exceptional air quality.

5. Daytona Beach, FL

Daytona Beach, FL took the fifth spot on this list with above average scores in all three of the AAFA’s key ranking factors, and it’s also been listed as one of the best places to live for allergy sufferers making it an ideal choice for allergy asthmatics.

6. El Paso, TX

El Paso, TX lands in the sixth spot on this list and is notable for its low number of asthma-related emergency room visits and low asthma-related death rate. Furthermore, the city also has an Asthma and Allergy Coalition, which aims to improve the quality of asthma and allergy care by raising awareness and hosting events including screenings and health fairs.

7. San Antonio, TX

San Antonio, TX made the list with the seventh spot despite the city’s high prevalence of asthma in children and notable pollen count, but this is because it ranks better than average among other ranking factors and the city also has a coalition working to provide in-home asthma treatment for children in need.

8. San Jose, CA

San Jose, CA takes the eighth spot for its low number of asthma-related emergency room visits in addition to its tough anti-smoking laws and it’s “Spare the Air” initiative which aims to plant more trees and promote cleaner energy sources resulting in better air quality. 

9. Palm Bay, FL

Palm Bay, FL took the ninth spot as a result of its low prevalence of asthma, but even for those with asthma symptoms may be less severe due to the city’s low pollen count and high air quality.

10. Provo, UT

Provo, UT took the tenth and final spot on this list due to its low prevalence of asthma and low number of asthma-related emergency room visits. Furthermore, the dry climate prevents pollen and other allergens from staying airborne for long — which may help asthmatics and individuals who regularly deal with allergies.


How to Help Relieve Asthma Symptoms

If you happen to live in one of the worst cities for asthma, there are still things you can do to help relieve asthma symptoms for asthma sufferers in your home. Here are steps you can take to ensure your child’s health is at his or her best.

Step 1: Clean constantly

Constant vacuuming and dusting in the home can prevent excess dander and allergens from affecting your child’s lungs. Washing bed sheets weekly and clothes routinely can remove allergens from your child’s bed and allow them to breathe and sleep easier.

Step 2: Develop a close relationship with your child’s school

If your son or daughter is not homeschooled, keep a close relationship with the nurse, teachers, and staff at their school. Your child spends the majority of their time at school and taking the time to talk to their nurse and teachers can ensure that the school knows what to do in case of an emergency.

Step 3: Invest in a dehumidifier

If humidity triggers your child’s asthma, investing in a dehumidifier can help if you live in a humid climate. A dehumidifier can lower humidity levels in your child’s room and help calm their asthma.

Step 4: Invest in an air purifier

We recommend buying an air purifier not only because we’re an air purifier company but because it helps a tonIndoor air is 3-5 times more polluted than outdoor air. Our True HEPA air purifiers can filter up to 99.99 percent of airborne particles down to 0.1 microns, removing irritants and providing you and your child with clean, fresh air.

HEPA Home Air Purifiers for Asthma Relief

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