If you have asthma, where you live can make a difference. Air pollution, secondhand smoke, and pollen are common triggers. No cities are asthma-free, but in some, it's harder to live with and control. Each year, the Asthma and Allergy Foundation of America ranks the most challenging among the 100 largest U.S. cities. Here are its Top 10 "Asthma Capitals" for 2014.
No. 10: Detroit, Mich.
Poverty plays a big part in the asthma troubles of more than half of the top 10 cities, including Detroit. Rates are high among children and adults in this city. But families often don't have access to care, and schools don't have funding for nurses. Mobile health clinics and a school campaign to boost asthma knowledge may be helping, so kids don’t miss too much school.
No. 9: Chicago, Ill.
People here are twice as likely to end up in the hospital for asthma than elsewhere in the U.S. And African-Americans in Chicago are five times more likely than white people to die of it. In some parts of the city, more than half of the children who have it live with a smoker. Children who breathe secondhand smoke are more likely to get asthma and have severe attacks.
No. 8: Tulsa, Okla.
High pollen counts help put Tulsa and Oklahoma City in the Top 10. Pollen can trigger allergic asthma, the most common type. Both asthma and allergy symptoms rage in Tulsa in fall, when ragweed peaks. And climate change is making the season harder and longer for people with allergic asthma. If you have it, you should get care from your doctor.
No. 7: Fresno, Calif.
Poverty and poor air quality help make Fresno a hotbed for children's asthma in California. More than 1 in 5 children here have it. Of children who use medication, nearly two-thirds still don't have good control of their symptoms. Better education and cleaner air could cut missed school days and hospital stays.
No. 6: Chattanooga, Tenn.
The average asthma rates here are lower than the rest of the nation’s, but this city has higher-than-average ER visits. Most likely this is because asthma is poorly controlled. One measure of control is how often you need to use quick-relief inhalers. In the U.S., 20% of people who say they have moderate asthma also say they use rescue inhalers at least once a day. With the right daily medications, you should need a rescue inhaler only about twice per week.
No. 5: Philadelphia, Pa.
Among the Top 5 worst asthma cities, Philadelphia has the poorest air quality, with too many unhealthy ozone days. Emergency room visits for asthma are the highest in the state. African-Americans in the U.S. are three times more likely than white people to die of it. But in Pennsylvania, it’s worse: Asthma deaths are four times more common among African-Americans. Proper treatment and care could prevent many of these deaths.
No. 4: Oklahoma City, Okla.
Oklahoma's capital is climbing the list of worst asthma cities. Having a high number of smokers doesn't help. Smoking bans in some jobs and non-smoking sections in restaurants make it easier to avoid secondhand smoke. But about one-third of Oklahomans with asthma are smokers. Even with mild to moderate asthma, smokers have worse symptoms and go to the hospital for attacks more often.
No. 3: McAllen, Texas
In this border city near the Rio Grande, a big problem is access to treatment. Too many people without insurance don't have daily medication to prevent asthma, or rescue medicine for attacks. One of the best ways to prevent attacks is to know what causes them, like dust mites, mold, colds, and exercise. With regular medical care, people here could get personal action plans to avoid their triggers and help their symptoms.
No. 2: Memphis, Tenn.
This Mississippi River town can't shake its spot near the top of the chart. Weak anti-smoking laws, year-round pollen, and low use of medications lead to too many asthma deaths here. Nationally, asthma causes more than 3,300 deaths each year.
No. 1: Richmond, Va.
The capital of Virginia is also the asthma capital of the nation, climbing back up from No. 23 last year. The city has high levels of year-round pollen and poverty, and too many people don't have health insurance. But a smoking ban and more asthma doctors could help bring down emergency room visits. Until the city takes more action, it's the hardest place to live for people trying to get control of their asthma.
Brighter Spots for Asthma
Of the 100 cities ranked, these 10 are the best. For the most part, they have less poverty, better school asthma programs, and better access to health care. But they also have cleaner air and good smoking bans. The result: fewer ER visits and deaths, and easier living with asthma. Here’s the list:
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American Academy of Allergy Asthma & Immunology: "Allergic Asthma," "Climate Change and Outdoor Allergies," "Inhaled Asthma Medications: Tips to Remember," "Cigarette smoke and severe asthma – a harmful mix."
American College of Allergy, Asthma & Immunology: "Asthma Treatment Options," "Proper Use of Asthma Medication."
American Lung Association: "Detroit, Michigan: Extensive Team Effort throughout an Urban System," "Secondhand Smoke and Asthma."
Americans for Nonsmokers' Rights: "Oklahoma."
Asthma and Allergy Foundation of America: "Asthma Capitals 2014," "Asthma Facts and Figures," "Press Release – Cities That Take Your Breath Away," "Richmond Is Top 'Asthma Capital' Again."
California State University, Fresno: "Struggling for Breath: The Epidemic of Asthma Among Children and Adolescents in the San Joaquin Valley."
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.