Worst U.S. Cities to Visit with Asthma

Worst U.S. Cities to Visit with Asthma

Asthma is a serious breathing condition that involves the constriction and swelling of airways, as well as excess production of mucus, which makes breathing difficult or problematic. It’s considered a chronic condition that can worsen with time or in response to environmental factors if it goes untreated.

About 25 million people in the United States alone have been diagnosed with asthma — that’s one in every 12 people. In 2007 alone, 3,447 people died of complications related to asthma. [1] Asthma ranges in severity from mild to extremely life threatening, and symptoms can be triggered by a variety of factors including exercise, fumes, gas, and allergens like dog dander and pollen.

There are three main classifications of asthma. Occupational asthma is caused by inhaling fumes, gas, or dust on the job. Childhood asthma often appears before the age of five, and the symptoms include wheezing, coughing, labored breathing, and weakness or exhaustion. Like adult asthma, it cannot be cured, but there are steps that you can take to control the symptoms and mitigate any potential damage to growing lungs. Allergic asthma is caused by a pre-existing allergy which triggers symptoms like inflamed airways, coughing, and wheezing.

There are some cities where living with asthma is easier, and others that make daily life for asthma sufferers quite difficult.

This year, the Asthma and Allergy Foundation of America (AAFA) ranked the worst cities for asthma sufferers in the United States, based on factors like asthma-related fatalities, number of reported emergency room visits, and asthma prevalence. [2] Here are some of the worst cities in the United States for people with asthma.

10. Toledo, Ohio

Toledo, Ohio, was ranked the 10th worst city in the United States to live with asthma. It’s the only city on our list today that’s actually considered average in terms of its overall rankings, but it’s placement in the country’s “asthma belt”, as well as its extremely high rates of quick-relief medicine use (the highest in the country) ensured its rank as one of the worst American cities for asthma sufferers.

The reason why using quick-relief medicine is counted in these rankings is because having the medicine in the first place is a sign that the person’s asthma is a continual issue.

9. Greensboro, North Carolina

The next city on our list is Greensboro, North Carolina, a city that is worse than average for asthma sufferers. It had an extremely high rate of emergency room visits for asthma-related conditions, which means that people in Greensboro are either unable to control their condition or lack proper medical care to help educate them in the first place.

Greensboro is located in the Northeast Mid-Atlantic asthma belt, which are cities that have a high poverty level, low air quality, and minimal access to specialists.

8. Birmingham, Alabama

Birmingham is ranked as the eighth worst city in the country for asthma, and one of the reasons is because of their lack of qualified pulmonologists. The current wait time in the city has been reported at 11 months. The result of these long wait times is that people are forced to go to the emergency room if they need treatment and lack the necessary education to avoid triggers.

7. Youngstown, Ohio

There are several cities in Ohio that populate the list of worst cities in the U.S. for asthma-related conditions, including Youngstown, a small city with a population of roughly 67,000.

Many factors in the Ohio-Lake Erie area contribute to the region’s large number of asthma sufferers, including pollen count and air quality. Youngstown is near many larger cities, which could influence the air quality. Youngstown is considered above-average for risk factors related to asthma.

6. Cincinnati, Ohio

Another Ohio town that’s on the list of the 10 worst cities in the United States for people with asthma is Cincinnati, a larger city that’s one of the worst in this region’s asthma belt for factors like air quality and number of emergency room visits. Cincinnati also has a poverty rate of 16 percent, which is a major factor that explains why fewer people in the city are able to access preventative medicine and health care.

5. Louisville, Kentucky

Louisville, Kentucky, ranks towards the middle of our list, but actually has the highest rates of asthma prevalence in the United States. With regards to other related factors, like death rate and number of emergency room visits, Louisville was better than average. However, the sheer number of people in Louisville who have some form of asthma earns it a place on the list. Louisville is the largest city in Kentucky, and the only one that ranks even close to the top of the AAFA’s list.

4. Philadelphia, Pennsylvania

The only Pennsylvania city to appear on this list is Philadelphia, which could be related to the fact that it has an extremely high rate of poverty. Quick-relief medicine like inhalers and nebulizers can be expensive, and so is preventative health care.

Many people with asthma in Philadelphia complain that the poor air quality and airborne pollution triggers their symptoms, forcing them to rely on air purifiers. There are also very few pulmonologists in the Philadelphia area that treat childhood asthma, forcing parents to travel long distances in search of specialists for their child.

3. Dayton, Ohio

Dayton is another Ohio city that has the dubious honor of being the worst city for asthma sufferers in the Ohio-Lake Erie asthma belt. Dayton has extremely high rates of poverty — 18.2 percent on average — and also has extremely high rates of quick-relief medicine usage. The third highest in the country, in fact. Using quick-relief medicine more than twice a week means that your asthma has spun beyond your control.

2. Richmond, Virginia

Richmond, Virginia, is the city in the United States that has had the most asthma-related fatalities this year. This is a frightening statistic because asthma-related deaths are often preventable. Both adults and children need to be educated on their condition, or they risk a sudden asthma attack ending their life.

1. Springfield, Massachusetts

This year, the AAFA used a ranking system to quantify the risk factors and assigned each city a numerical score. The average was 61.84. Springfield, Massachusetts, the worst city in the country to live with asthma in 2018, scored an unbelievable 100 — a full 19 points above the second-worst city.

Poverty, air quality, and access to specialists are some of the challenges that Springfield faces if it wants to improve the quality of life for its citizens suffering from asthma.


  1. “Asthma in the US.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 May 2011, www.cdc.gov/vitalsigns/asthma/index.html.
  2. “The Most Challenging Places to Live With ASTHMA.” Asthma and Allergy Foundation of America , 2018, www.aafa.org/media/AAFA-2018-Asthma-Capitals-Report.pdf.