Top 10 Best and Worst Places to Live with Asthma

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. This article was updated again in June 2024 with a broad focus on Top 10 Best and Worst Places to Live with Asthma.

Ok, so it’s not all bad news. Alen is here to help you achieve your best air quality no matter where you live. Yes, asthma is a concern and it’s prevalent. That’s right, you’re not alone. Over 25 million Americans live with asthma, and where they live can dramatically affect the severity of their daily symptoms. But with Alen on your side, you can live happily anywhere.

You’re probably understandably concerned about how the city you live in affects you or your child’s asthma symptoms. We’ll list each of the top 10 best and worst places to live with asthma and give you tips on managing your asthma-related symptoms. We also understand how worrisome it is for parents of asthmatic children. It’s important to know that where you live affects the severity of your child’s asthma. The good news is that Alen's home air purifiers can help you create a safe and healthy home. 

Here's our list of the 10 worst cities for asthma sufferers: 

1. Allentown, PA
2. Lakeland, FL
3. Charleston, SC
4. Cleveland, OH
5. Detroit, MI
6. Poughkeepsie, NY
7. Richmond, VA
8. Philadelphia, PA
9. Fresno, CA
10. Rochester, NY

10 Worst Places to Live with Asthma

The 10 best and worst cities to live with asthma is based on research from a 2023 report by the Asthma and Allergy Foundation of America (AAFA), which analyzed the top 100 U.S. metropolitan cities. The report considers asthma prevalence, asthma-related emergency department visits, and asthma-related deaths. The study also analyzed other risk factors that can influence asthma outcomes–poverty, air quality, access to specialist medical care, pollen allergy, medicine use, tobacco policies, and lack of health insurance. We’ll break it all down for you.

Let’s start with the worst cities to live in if you suffer from asthma. Each city analyzed in the AAFA study is ranked from 1-100, with 1 being the worst city to live with asthma and 100 being the best. It’s important to emphasize that asthma varies from person-to-person. Local allergies and asthma triggers can cause differences in each person’s experience by location. So here we go–the cities that received the worst 2023 overall rankings are as follows:

 (Source: AAFA) 

1. Allentown, PA

Allentown, Pennsylvania was ranked as the number one worst place to live and one of the asthma capitals due to its extremely high estimated asthma prevalence, emergency department visits, and alarming crude death rate for asthma. It also ranked as the number one worst place regionally in the Northeast.
Allentown has a mix of industrial and vehicle pollution, a climate with cold winters and humid summers, and high seasonal pollen counts. These factors can worsen asthma symptoms, with environmental pollutants and allergens being significant triggers.

2. Lakeland, FL

Lakeland, Florida is ranked second for its high scores related to estimated asthma prevalence and emergency department visits. Regionally, it ranked as the number one worst place for asthma in the South and, according to the risk factor assessment, was number 7 on the list of highest number of uninsured residents and number 10 for most quick-relief medicine use.

3. Charleston, SC

Charleston, South Carolina ranked as the third highest city. It also ranked high and scored in the red zone for estimated asthma prevalence and emergency department visits, and yellow zone for the crude death rate. Moreover, Charleston has high humidity, which promotes mold and dust mite growth, and a long pollen season that can worsen allergy symptoms. Air quality issues from traffic, industrial pollution, and wildfires may also trigger asthma attacks.

4. Cleveland, OH

Cleveland, OH ranks fourth and number one in the Midwest due to its poor air quality and alarming red zone scores for all components, including high estimated asthma prevalence, emergency department visits for asthma alone, and crude death rate for asthma.

5. Detroit, MI

Detroit, Michigan is ranked fifth as it has one of the highest rates of poverty and received an F rating from the American Lung Association’s 2023 State of the Air Report for high ozone days and particle pollution.

However, Detroit is one of the few cities to be a part of AAFA’s Health Equity Advancement and Leadership (HEAL) program. In collaboration with the AAFA Michigan Chapter, the Detroit program provides a holistic asthma management intervention. Participants are provided with comprehensive self-management asthma education, connected with an asthma specialist and a nutritionist, and receive a virtual home environmental assessment from a certified community health worker. Participants are also provided with a local farmer’s market food box, a membership to a local YMCA, and asthma-friendly products for their homes.

6. Poughkeepsie, NY

Although Poughkeepsie, New York scored better than average for its asthma-related emergency department visits, it ranked sixth and as the second worst city in the Northeast, was number one for the estimated asthma prevalence across all of the cities–making it one of the asthma capitals–and was first for having the fewest asthma specialists per asthma patient.

7. Richmond, VA

Richmond, Virginia ranks seventh for scoring worse than average on numerous measures, including ranking sixth on the list of highest asthma-related emergency department visits, third worst in the South, and second in most asthma-related deaths.

8. Philadelphia, PA

Philadelphia, Pennsylvania ranks eighth for having worse than average scores for asthma-related deaths, fifth for poverty, and the third worst city in the Northeast. It is also one of the most challenging cities to have asthma because of its high levels of air pollution from traffic and industrial activities, significant seasonal allergens, and extreme weather fluctuations.

9. Fresno, CA

Fresno, California is ranked ninth. The worst city in the West for asthma, Fresno ranked as the fifth highest city for prevalence of asthma, sixth highest for recorded asthma-related deaths, and also received an F rating from the American Lung Association’s 2023 State of the Air Report for high ozone days and particle pollution. Fresno was also ranked seventh for having the fewest asthma specialists per asthma patient.

10. Rochester, NY

Rochester, New York is in the tenth spot–the fourth worst city in the Northeast, Rochester has the ninth highest recorded prevalence of asthma and ranks third for quick-relief medicine use. Rochester reported average and worse than average scores for many of the measures.

10 Best Places to Live With Aasthma

Ready for the good news? There are lots of great cities where you can live with asthma. The cities that the AAFA rates highest in the 2023 overall rankings are as follows:

(Source: AAFA)

1. Provo, UT

The number one best place to live if you have asthma is Provo, Utah due to its low reported prevalence of asthma, asthma-related death rate, and low number of asthma-related emergency room visits. However, it received an F rating from the American Lung Association’s 2023 State of the Air Report for high ozone days and particle pollution. Yikes!

2. Salt Lake City, UT

Salt Lake City is ranked as the second best city to live with asthma. With an overall low prevalence of asthma in the city, and low emergency department visits, Salt Lake benefits from excellent medical facilities and a clean natural environment for outdoor options. However, it also received a poor rating for high ozone days and particulate pollution

3. Oxnard, CA

Oxnard, California ranks third–the city reported exceptionally better than average scores for the criteria set by the AAFA. Oxnard also has excellent air quality and a mild coastal climate. The consistent ocean breezes help to clear and refresh the air, reducing the presence of pollutants and allergens, while the city's moderate temperatures prevent the extreme conditions that often trigger asthma symptoms.

4. Madison, WI

Ranked fourth is Madison Wisconsin, with low reports of both overall prevalence and deaths from asthma, it offers a combination of good air quality, excellent healthcare, proactive environmental policies, and supportive community programs for managing childhood asthma.

5. Durham, NC

Durham, North Carolina ranks fifth as it is one of the few cities that reported better than average scores for all of the measures. However, it ranks sixth on the list of cities that do the least to protect their residents and visitors from tobacco smoke and has fewer smoke-free laws.

6. Little Rock, AR

Little Rock, Arkansas ranks sixth with a low asthma prevalence and death rate comparatively. It is a potentially good place for managing childhood asthma thanks to its healthcare resources, supportive community programs, and a climate that avoids weather extremes that can worsen asthma symptoms.

7. Ogden, UT

Ogden, Utah ranks seventh for its combination of high air quality, dry climate, and excellent outdoor and health facilities. Along with its low asthma prevalence and emergency department visits, Ogden is an environment where managing asthma could be easier compared to more humid, polluted, or densely populated urban areas.

8. Winston-Salem, NC

Winston-Salem ranks eighth as it offers a supportive healthcare network, a beneficial climate, and community resources aimed at promoting a healthy lifestyle and effective asthma management. However, it ranked as one of the cities that does the least to protect its residents and visitors from tobacco smoke and has fewer smoke-free laws, comparatively.

9. New Haven, CT

New Haven ranks ninth as the best place to live with asthma. Along with its low asthma prevalence and emergency department visits, it is a supportive place for managing childhood asthma since it provides strong healthcare options, educational resources, and community programs with green initiatives. However, it ranked sixth for having the fewest asthma specialists per asthma patient.

10. Raleigh, NC

Raleigh, North Carolina takes the tenth spot for its temperate climate, high-quality healthcare facilities, proactive air quality initiatives, and low prevalence of asthma cases and related deaths. The city also offers abundant green spaces and community programs focused on health and wellness, which support effective asthma management.

How Does Where You Live Affect Your Asthma?

You might wonder what places you should avoid. Did you know that valleys, inner-cities or heavily forested areas can be asthma aggregators? Valleys 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 have heavy pollution due to excessive population, and smoke emitted from cars and trucks. Cities without smoking laws are even worse, as secondhand smoke is hazardous to children with asthma. If you live in one of these areas–not to worry. You can choose VOC  air purifiers to lessen or reduce the effects of these pollutants. For example, our VOC/Smoke filters have more activated carbon designed to capture smoke and chemicals.

There’s more–the type of climate in a city can affect asthma symptoms. Cold, dry air causes the airways to narrow–not an ideal choice for asthmatics triggered by lower temperatures. By contrast, 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. Cities with lots of trees and greenery can irritate children allergic to tree pollen and grass. Who knew there was a downside to city parks?

If you know these environmental factors affect you or your child’s asthma symptoms, consider using an air purifier such as the Alen BreatheSmart FLEX to provide relief so you can breathe better indoors. The Alen BreatheSmart FLEX operates powerfully yet quietly. It is highly customizable with advanced filtration technology to capture a broad spectrum of airborne particles. Suitable for medium-to-large spaces in residential and office settings, the FLEX ensures a clean, healthy environment for you and your family. You’ll be glad to know that maintenance is minimal and user friendly. The FLEX’s customizability, filtration system, and advanced technology make it an excellent choice for you as you seek to take control of your indoor air.

How Does Asthma Affect Children In Particular?

If you’re the parent of a child with asthma you know that it is a long-term lung disease that inflames and narrows airways, making it difficult to breathe. We understand how worrisome it is for parents of asthmatic children. It’s important to know that where you live affects the severity of your child’s asthma. Asthma can be caused by a number of factors that irritate the lungs.

Asthma is especially dangerous to children because of their small lungs.This makes children more sensitive to asthma triggers, which can include humidity, pollution, pollen, exercise, or other allergies and irritating particles like mold or smoke. One suggestion is to try to develop a close relationship with staff at your child’s school. If your child is not homeschooled, keep a close relationship with the nurse, teachers, and staff at their school. Taking the time to talk to the nurses and teachers can ensure that the school knows what to do in case of an emergency.

How to Help Relieve Asthma Symptoms

There’s more good news. Alen can help you improve your air no matter where you live. If you happen to live in one of the worst cities for asthma, Alen can help you take control of your air when the conditions are not ideal. Here are some of our top tips on how you can relieve symptoms for the asthma sufferers in your home:

Step 1: 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 ton. Indoor air is 3-5 times more polluted than outdoor air. Alen’s HEPA (High-Efficiency Particulate Air) air purifiers can filter up to 99.9% of airborne particles down to 0.1 micron. Be the hero of your home by removing irritants so you and your child can breathe clean, fresh air.

Alen’s air purification process is innovative and straightforward. Air purifiers work by passing air continuously through the unit to capture particulates. Dust and pollen are captured by our HEPA filter whereas volatile organic compounds (VOCs), smoke, and other non-particulate pollutants are captured by our FRESH filter which has activated carbon. The process depends on the series of filters used in our air purifiers as different types of filters target different pollutants.

Step 2: Clean regularly to keep those pesky allergens away

Regular vacuuming and dusting in the home can prevent excess dander and allergens from affecting your lungs and removes many of the common asthma triggers from your environment. Washing bed sheets weekly and clothes routinely can remove allergens from your child’s bed and allow them to breathe and sleep easier.

Step 3: Plan ahead

Have a personalized asthma action plan developed with healthcare providers, understand how to recognize and manage symptoms, and ensure regular medical check-ups to adjust asthma treatment as needed.

Step 4: Purchase a dehumidifier

If humidity triggers your or 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 reduce asthma-related symptoms.

Other Tips For Managing Your Child's Asthma Symptoms

We’d like to offer some other helpful tips. From simple lifestyle adjustments and medications you can effectively manage your asthma symptoms and breathe easier. Here are our top tips:

• Monitor Air Quality: Check air quality forecasts and minimize outdoor activities when air pollution levels are high.
• Diet: A diet rich in fruits, vegetables, and omega-3s can boost immune function and reduce inflammation.
• Regular Exercise: Controlled exercise can enhance lung function and overall health in asthma management, but it should be moderate, preceded by medicated warm-ups, and tailored to avoid triggering asthma symptoms.
• Rescue Inhalers (e.g., albuterol): Be sure to have one on hand wherever you go. These are used during asthma attacks to open up the airways quickly.
• Stress Management: Stress management through mindfulness or yoga can help mitigate asthma symptoms.
• Medications: Daily controller medications like inhaled corticosteroids (e.g., fluticasone, budesonide) and combination inhalers help reduce airway inflammation. Additional treatments may include oral leukotriene modifiers (e.g., montelukast) for allergic asthma or severe cases might require biologics like omalizumab, administered via injections.

Let’s Wrap It Up

There’s no doubt that where you live can dramatically affect the quality of life for you and your family, especially if you are dealing with asthma. The great news is that Alen can help you create a safe and healthy home throughout it all, even if you happen to live in one of the worst cities we’ve listed. That’s right! Alen is your partner in achieving good, clean air in your home–no matter where you live. Together we can enhance your air with the best home air purifier that puts you in complete control.