Managing asthma can be a challenge. Living in the right place can make a difference between having frequent asthma attacks or attacks once in a while.

Understanding asthma
Asthma is a lung disease. It causes inflammation of the airways that carry air to and from your lungs. As a result of inflammation, your airways tighten. This makes it harder for you to breathe.

More than 25 million people have asthma. Asthma may occur at any age, but it often begins in childhood. Researchers estimate that 7 million children have asthma.

Asthma isn’t curable. However, you can control it by making lifestyle changes and by taking certain medications. Flare-ups may happen at any time, even if you have well-controlled asthma.

Some people with asthma have symptoms almost all of the time. Others only get symptoms from certain triggers, such exercise, cold air, or specific allergens. Asthma symptoms are serious. They may include:
  • shortness of breath
  • wheezing
  • chest tightness
  • chest pain
  • coughing, which is worse at night or early in the morning
  • worsening cough and wheezing if you have a respiratory illness, such as a cold or the flu
  • trouble sleeping due to coughing, chest discomfort, and wheezing

The impact of asthma is staggering. According to the Asthma and Allergy Foundation of America (AAFA), asthma is responsible for 2 million emergency room visits, 14 million doctor visits, and 439,000 hospitalizations each year.

If environmental factors affect your asthma, it may be difficult to spend quality time outside. You may feel isolated and miss time at work or school. Research shows children with asthma have an increased risk of depression and low self-esteem.

Possible causes of asthma
Researchers believe genetic and environmental factors cause asthma.

How your environment affects asthma
Some people develop occupational asthma as a result of working with chemicals or exposure to workplace dust. Most people can identify which environmental pollutants or allergens trigger their asthma attacks. These can include:

  • flower, tree, and grass pollen
  • pet dander
  • mold
  • dust mites
  • cockroaches, including their remains and droppings
  • cigarette smoke
  • industrial air pollution
  • Risk factors

The following factors increase your risk of getting asthma:

  • having a close family member with asthma
  • being overweight
  • being a smoker
  • being exposed to environmental or occupational pollutants

Even if you take medications, it may be difficult to manage asthma if you live in an environment where you are continually breathing impure air.

Ranking where you should live if you have asthma
The United States is full of exciting places to live with diverse cultures and dynamic cities, but not every city is healthy. Many are full of pollutants, such as air pollution and pollen. These can aggravate asthma.

Each year, the AAFA researches the most and least challenging places to live in the United States if you have asthma. They take the following into consideration:

  • asthma occurrence rates
  • environmental conditions
  • healthcare, including asthma medication use and issues such as emergency room visits
  • public smoking laws
  • poverty rates

After compiling the information, the AAFA publishes that year’s Asthma Capitals Report. The report ranks the 100 largest metro areas.

The AAFA gave all states a better-than-average score for school inhaler access laws in their 2015 report. According to this report, these are the best and worst places to live if you have asthma:

The best U.S. cities to live in if you have asthma

Best cities

  • San Francisco, California
  • Boise, Idaho
  • Seattle, Washington
  • San Jose, California
  • Abilene, Texas
  • San Francisco, California

The City by the Bay earned the No. 1 ranking thanks to great public smoking laws, air quality, and low pollen counts. The city went the extra mile by creating an Asthma Task Force to help prevent asthma and improve the quality of life for people with the condition.

Boise, Idaho
Not only is Boise a great place to find potatoes, but it’s also a great place to live if you have asthma. The city got high marks for better-than-average pollen scores, emergency room visits, and use of medications.

Seattle, Washington
Even though there’s room for Seattle to improve their public smoking laws, the city’s better-than-average air quality, pollen score, and healthcare helped it earn a top spot.

San Jose, California
San Jose’s Spare the Air program is at least partially responsible for its high ranking. The city’s air quality is average, but it earned better-than-average marks across the board for healthcare, pollen score, and public smoking laws.

Abilene, Texas
Despite Abilene’s average air quality and public smoking laws, and below average pollen score, its better-than-average asthma rates and healthcare kept it in the top five.

The worst U.S. cities to live in if you have asthma

Worst cities

  • Memphis, Tennessee
  • Richmond, Virginia
  • Philadelphia, Pennsylvania
  • Detroit, Michigan
  • Oklahoma City, Oklahoma
  • Memphis, Tennessee

Although Memphis is known as “the birthplace of rock ‘n’ roll,” it’s also earned the nickname “asthma capital of 2015.” The city received a below average score for asthma death rates, pollen score, public smoking laws, and almost every healthcare factor.

Richmond, Virginia
The beautiful historic city of Richmond trails Memphis as the worst place to live with asthma by a small amount. It ranked below average for:

  • asthma death rates
  • pollen scores
  • public smoking laws
  • emergency room visits
  • use of medications
  • Philadelphia, Pennsylvania

When it comes to healthy air, the City of Brotherly Love isn’t a welcoming place for asthmatics. Philadelphia earned a below average score for:

  • air quality
  • public smoking laws
  • asthma death rates
  • emergency room visits
  • use of quick-relief medications 
  • Detroit, Michigan

Detroit received a better-than-average- pollen score, but it received average or below average scores for all other factors.

Oklahoma City, Oklahoma
This city fell short across the board. Their 2015 ranking was worse than the ranking for the previous year, and it received below average scores for pollen, public smoking laws, and use of medications.

What you can do
Asthma is a serious, chronic disease that may negatively impact your quality of life. Although it’s not possible for everyone with asthma to move to a less polluted city, it’s something to think about. For some people, improved quality of life is worth the inconvenience of moving.

The following are additional steps you can take:

Research your city’s air pollution. It’s possible that pollution levels where you live may be making your asthma worse.

Try to limit your exposure to asthma triggers.

Work with your doctor to find medications to control your symptoms and to develop an asthma action plan for what to do during flares.


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