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by Catherine Poslusny

When you have asthma, being exposed to certain environmental triggers can cause severe breathing difficulties. Consistent exposure to these triggers could make asthma symptoms worse, negatively impacting your quality of life. According to the CDC, over 26 million people living in America currently suffer from some sort of asthma. If you are one of these people, you have probably spent some time researching how to breathe easier by avoiding things that make your asthma worse.

Did you know that certain parts of the country present different obstacles to people living with asthma? Some cities or regions are known for poor air quality or high pollen counts that make it difficult for people with asthma to manage their symptoms. Here’s how to know whether the area you live in could be making your asthma worse, along with helpful tips to breathe easier despite environmental triggers.

The Asthma and Allergy Foundation of America 2018 Report

Each year, the Asthma and Allergy Foundation of America compiles data from across the nation to create a list of the top 100 worst U.S. cities for people with asthma. Their goal is for people living in these cities to recognize the environmental triggers and take additional steps to keep their asthma symptoms under control.

To rank the cities, the AAFA looked at a variety of factors, including asthma rates by city, asthma-related emergency room visits and asthma-related mortality. Additionally, the report looked at environmental risk factors such as air quality, pollen counts and municipal tobacco policies. Other environmental factors that contributed to the results are poverty levels, access to respiratory specialists, medicine use and the percentage of uninsured patients in the area.

Worst places to live for asthma sufferers

If you have asthma and you live in — or are considering a move to — one of these cities, you might have a more difficult time controlling your asthma symptoms. People with asthma may live happily in these cities, but it may require some research on the proper ways to counteract or mitigate the high levels of environmental triggers.

Top 5 worst cities for asthma sufferers

These cities were ranked based on their air quality, the proportion of residents with asthma and the number of asthma-related medical incidents.

#5: Louisville, Kentucky

Louisville KY

Louisville has a higher prevalence of asthma than any other city in the United States. Additionally, it is ranked fourth in the nation in long-term asthma control medication use.

#4: Philadelphia, Pennsylvania

Philadelphia PA

Philadelphia is eleventh in the nation in asthma prevalence, but it is sixth in the nation in asthma-related deaths. This city is also ranked fifth in the nation in poverty, which affects how well the general population is able to treat and control asthma symptoms.

#3: Dayton, Ohio

Dayton was found to be the worst city in Ohio, and the entire Midwestern United States, for people with asthma. The city is fourth in the nation in asthma-related emergency room visits. Additionally, it is ranked third in both quick-relief and long-term asthma control medication use.

#2: Richmond, Virginia

Richmond was ranked first in the nation for asthma-related deaths and sixth in asthma-related emergency room visits. Richmond has the second-highest poverty level and third-highest pollen levels out of the cities in the AFAA report.

#1: Springfield, Massachusetts

Springfield MA

The worst city in the United States for people living with asthma, Springfield, Massachusetts is home to the highest number of asthma-related emergency department visits in the nation. This city is tenth in the nation in asthma prevalence and has the seventh-highest pollen levels of the cities tested.

The worst states and regions for people with allergies and asthma

Ohio and Massachusetts were found to have the most cities that ranked in the top 20 worst places to live with asthma, but asthma triggers do not necessarily follow state lines. When compiling data for the 2018 report, the AAFA found two specific regions that seemed to have worse-than-average environmental conditions for people living with asthma. These regions are specifically outlined by the AAFA as “asthma belts” because they each have a high proportion of asthma capitals:

  • Ohio-Lake Erie Asthma Belt—This region is home to 8 of the 20 worst cities for asthma sufferers, including Louisville, Kentucky; Detroit, Michigan and the six Ohio cities that ranked on the list.
  • Northeast Mid-Atlantic Asthma Belt—The AAFA theorizes that poverty, air quality and access to specialists may factor into why many cities in this region are potentially hazardous for people with asthma. The region is home to 9 of the top 20 worst cities for asthma sufferers, including Springfield, Massachusetts; Richmond, Virginia and Philadelphia, Pennsylvania.

For a comprehensive list of the worst cities for asthma sufferers, read the full AAFA 2018 report.

What specific environmental triggers should you consider?

Many factors work together to cause certain locations to be harmful to people with asthma, but why exactly do these conditions affect asthma sufferers the way that they do? According to the CDC, asthma triggers include:

  • Tobacco smoke—While secondhand smoke is harmful to everyone that comes in contact with it, it is especially dangerous for people with asthma. Exposure to secondhand smoke could trigger an asthma attack. Therefore, cities with more lenient laws about smoking in public are likely to be more hazardous for asthmatics.
  • Outdoor air pollution—Pollutants in the air, whether from factory smoke, cars or other sources, can trigger a reaction in people with asthma. In fact, urban air pollution has been positively linked to asthma-related emergency room visits (Sunyer, et. al, 1997). Cities with more pollution, and lower air quality, pose more risks to people with asthma.
  • Weather—Bad weather days may trigger asthma symptoms. Some people react poorly to days with high humidity and thunderstorms, while others are affected by cold, dry weather. Knowing your weather-related asthma triggers can be a useful tool in deciding which city is right for you.
  • Pollen count—For people with asthma, pollen in the air may be just as bad as air pollution from manmade sources. Additionally, high levels of outdoor air pollution may actually make the effects of pollen worse for asthmatics (Knox, et. al, 2006). In some areas, pollen levels in the air may be cyclical, only causing problems for people with asthma during certain seasons. Other areas have high pollen counts year-round. If you are sensitive to pollen, it is worth looking into the amount and types of pollen present in your region.

Extra precautions for children with asthma

If you have a child with asthma, especially if you live in one of the regions listed above, you should take special precautions to help them control their asthma symptoms. According to the CDC, about half of all children with asthma experienced an asthma attack in 2016. Here are some helpful steps to protect your child:

  • Make sure that everyone in your family, including your child, knows what the warning signs of an asthma attack look like. Have an emergency treatment plan in place for when asthma symptoms start to flare up.
  • Keep your home free of potential triggers and consider adding an air purifier to your home.
  • Communicate with your child’s school about their needs and your concerns, especially when it comes to outdoor activities on poor air quality days.
  • Ensure that your child takes their asthma control medications as prescribed.

How can residents of “asthma capitals” deal with environmental triggers?

Asthma causes 2 million trips to the hospital each year, making it among the top 20 reasons that people in the United States visit the emergency room. Knowing and avoiding your individual asthma triggers can help you keep asthma symptoms under control.

  • Control the levels of environmental triggers in your home. This includes keeping a house clean of mold and smoke, as well as washing pets frequently.
  • Pay attention to air quality forecasts on the news and on websites such as Avoid going outside, or opening windows in your car or house, on days when air pollution is high. This includes days with high pollen counts. If you have to go outside on high pollen days, wash your clothes as soon as you get home to avoid transferring the pollen to the air in your home.
  • Ask someone who does not have asthma to help you maintain your yard. Additionally, you can choose plants for your yard that produce minimal pollen, such as Irish moss, bunch grass and dichondra.
  • Consider an air purifier to reduce indoor air pollution in your home. The Molekule air purifier can destroy pollutants in your home that may trigger asthma symptoms.

If you live with moderate to severe asthma, the best choice is always going to be to live somewhere with less environmental asthma triggers. Unfortunately, that is not always an option. By learning about the environmental triggers specific to your city, you can make a plan with your physician to manage your asthma and keep it from affecting your quality of life.

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