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    St. Louis a Challenge for Asthma Sufferers

    Midwestern City Tops List of 'Most Challenging' Places to Live If You Have Asthma
    WebMD Health News
    Reviewed by Louise Chang, MD

    Jan. 29, 2009 -- Residents of St. Louis can now shout "We're No. 1," but it's unlikely they'll want to crow about their brand new top ranking.

    The Midwestern city has been ranked No. 1 by the Asthma and Allergy Foundation of America as the nation's "most challenging" place for asthma sufferers to live, leaping from ninth on last year's list and 28th in 2007.

    The Asthma and Allergy Foundation of America, a Washington-based nonprofit organization, based its latest rankings on an analysis of 12 factors in the 100 largest U.S. metro areas.

    St. Louis was worst in average scores in crude death rate from asthma and higher than average in pollen counts over the previous year. St Louis also lacks public smoke-free laws, which the AAFA says other large cities are enacting.

    Reasons for St. Louis' rise include worsening air quality and an increase in the number of people without health insurance.

    Yet the prevalence of asthma, both estimated and self-reported, decreased in St. Louis over the past year.

    Knoxville, Tenn., ranked No. 1 last year, but fell to seventh in the 2009 listings, in part because pollen levels were lower than the national average.

    Mike Tringale, director of external affairs for the asthma organization, says there's no way for asthma patients to escape their disease, but that they can work with doctors to effectively control symptoms.

    The 10 worst asthma cities this year are:

    1. St. Louis, Mo.
    2. Milwaukee, Wis.
    3. Birmingham, Ala.
    4. Chattanooga, Tenn.
    5. Charlotte, N.C.
    6. Memphis, Tenn.
    7. Knoxville, Tenn.
    8. McAllen, Texas
    9. Atlanta, Ga.
    10. Little Rock, Ark.

    The Asthma and Allergy Foundation of America says it reviews 12 factors, including asthma deaths, estimated prevalence of pediatric and adult asthma, and risk factors such as air pollution, pollen counts, and public smoking laws.

    Medical factors also are taken into consideration, such as the number of asthma specialists in the area and the number of asthma medications used per patient.

    "For the last several years, I have seen an increase in our patients in the severity of asthma and how their life is affected by it," says Mario Castro, MD, MPH, professor of medicine and pediatrics at Washington University in St. Louis. "The lack of a smoke-free public environment for our patients with respiratory problems, especially asthma, in St. Louis is appalling."

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