Asthma Capitals

Pollen, secondhand smoke, and air pollution are common triggers of asthma. What is asthma? Asthma is defined as a respiratory condition marked by spasms in the bronchi of the lungs causing difficulty in breathing. Asthma is often triggered by an allergic reaction or other forms of hypersensitivity.


While there is nowhere you can live to escape asthma triggers, some areas are undoubtedly worse for asthma sufferers than others. Every year, the Asthma and Allergy Foundation of America ranks the top 10 “Asthma Capitals”—meaning the worst places to live for the asthma-prone.

The goal of the research project is to call attention to the asthma epidemic and to advocate for changes in each city to improve the quality of life for people with asthma. The ranking is based on the analysis of data from the 100 most-populated Consolidated Metropolitan Statistical Areas (MSA) in the U.S. It takes into account:
Prevalence factors (predicted, reported and recorded deaths of asthma cases)
Risk factors (pollen score, air quality, public smoking laws, poverty and uninsured rate, and school inhaler access laws)
Medical factors (ER visits for asthma, rescue and controller medication uses, and number of asthma specialists per patient)

The most recent top 10 list of the worst cities for asthma includes the following:

  • Detroit, Mich. (10)
  • Chicago, Ill. (9)
  • Tulsa, Okla. (8)
  • Fresno, Calif. (7)
  • Chattanooga, Tenn. (6)
  • Philadelphia, Pa. (5)
  • Oklahoma City, Okla. (4)
  • McAllen, Texas (3)
  • Memphis, Tenn. (2)
  • Richmond, Va. (1)

Richmond jumped from a number 23 ranking last year to its current number one spot, largely due to high levels of year-round pollen and the fact that many residents don’t have access to medical insurance. Poverty played a big role in the rankings, leading to such problems as lack of access to medical facilities and insufficient funds to hire an adequate number of health care workers including school nurses.

Smoking also influenced the pecking order. A number of the “worst 10” cities have a large number of smokers coupled with weak anti-smoking laws. Rankings were also affected by poor air quality and too many unhealthy ozone days. Climate change can influence allergies by making high allergy seasons (such as ragweed season) last longer, extending allergic and asthmatic misery.

So where should you live if you suffer from asthma? The AAFA also compiled a “best 10” list.

  • Madison, Wis.
  • Portland, Ore.
  • Des Moines, Iowa
  • Provo, Utah
  • Albany, N.Y.
  • Rochester, N.Y.
  • Spokane, Wash.
  • Boise, Idaho
  • Seattle, Wash.
  • and the best place to live if you have asthma is in San Francisco, California.

About The Author

Stuart H. Agren, M.D.

Stuart H. Agren, M.D. completed his undergraduate studies at the University of Utah and went on to earn his Doctor of Medicine from Tulane University School of Medicine in 1974. He completed additional training at L.D.S. Hospital in Salt Lake City, Utah and then established his private medical practice starting in 1975. Dr. Agren completed a mini-residency in Industrial Medicine at the Robert Johnson School of Medicine at Rutgers University and also completed training to become a certified Medical Review Officer.

Dr. Agren was the Medical Director at TRW and McDonnell Douglas in Mesa, Arizona and at Stauffer Chemical and Kennecott Copper in Salt Lake City, Utah. He also served as an adjunct faculty member at Arizona State University.

In his private medical practice, Dr. Agren specialized in family practice and allergy. In his work as a private practice allergist, he was one of the first doctors in the country to prescribe sublingual immunotherapy to his patients as an alternative to subcutaneous immunotherapy (allergy shots). He has also been a trailblazer in the field of food allergy treatment and research, developing a program to treat multiple food allergies simultaneously using sublingual immunotherapy. Dr. Agren has been featured on local CBS, NBC, and ABC news affiliates and won the peer-nominated “Top Doc” award from Phoenix Magazine.

After 20 years in private practice, Dr. Agren became the Founder and President of AllergyEasy, which helps primary care physicians around the country offer allergy testing and sublingual immunotherapy treatment to their patients. Over 200 physicians in over 32 states use the AllergyEasy program to help their patients overcome environmental and food allergies and asthma.