Asthma Capitals 

More than 25 million Americans have asthma. Tragically, 10 people die from it every day. Most of these deaths can be prevented with access to medical care, education on how to properly manage the disease, healthy housing and clean air. But asthma is still one of the most common chronic diseases in our nation. Asthma is one of the most common chronic diseases and costs our society $82 billion a year.

AAFA's Asthma Capitals™ ReportDownload PDF ranks the top 100 metropolitan cities that are most challenging to live in with asthma. We publish this report to help people who live in Asthma Capitals advocate for better care and policies. The report also shows how communities can best direct their focus to reduce the impact of asthma.

Out of the 100 Cities AAFA Ranked, the Top 20 Most Challenging Places to Live With Asthma Are:


Asthma Capitals: Full Report With Asthma Outcomes and Risk Factors

This comprehensive report identifies critical asthma outcomes in the 100 most populated metropolitan areas in the U.S. The ranking is based on weighted outcomes: asthma prevalence, asthma-related emergency department visits and asthma-related deaths. The report also analyzes eight risk factors that can influence asthma outcomes: poverty, lack of health insurance, air quality, pollen count, long-term control medicine use, quick-relief medicine use, smoke-free laws and access to asthma specialists. Our report reveals two “Asthma Belts” in the U.S: one in the Ohio Valley area and one in the Northeast Mid-Atlantic region. To show the impact of asthma in some of the top cities on our report, we profile patients, doctors and legislators who share their experiences of living with asthma in various cities across the U.S.



Asthma Capitals – Full Report and RankingsDownload PDF 

Press Release: 2019 Asthma Capitals™ Report Ranks the Most Challenging Cities in the U.S. for Asthma Download PDF 

Asthma Outcomes

Our report ranked the following asthma outcomes (not weighted equally). Within each outcome, we report the cities that ranked the highest.  

Asthma Prevalence (Occurrence)

Asthma prevalence is the number of people who have asthma. About 8.3% of Americans have asthma. Asthma rates are higher in low-income areas and among minorities. Our report looked at the number of people with asthma in each metropolitan area.

Asthma-Related Emergency Department Visits

Asthma is one of the top reasons for emergency department (ED) visits. An ED visit is one outcome of poorly controlled asthma. The number of asthma-related ED visits affected the overall rank of each city on our Asthma Capitals report.

Asthma-Related Mortality

Ten people die each day from asthma in the United States. Older adults and African Americans have the highest number of fatalities due to asthma. The number of fatal outcomes due to asthma influenced the overall rank of each city in our Asthma Capitals report.

Asthma Risk Factors

A risk factor is something that can increase your chances of getting asthma or make your asthma worse. We analyzed the following risk factors and their potential impact on asthma outcomes in each of the 100 largest U.S. metropolitan cities (the risk factors did not weigh into the ranking):


Poverty can play a major role in developing asthma and the ability to manage it. This can be because of poor rental housing, location near highways, inability to pay for treatment and more. Many cities on our report have poverty as a top risk factor.

Lack of Health Insurance

Asthma treatment can be expensive. People without insurance may not be able to pay for medicines and health care, causing them to have uncontrolled asthma.

Poor Air Quality

Harmful gases, like ozone, and small particles in the air, like smoke, can make asthma worse. Cities with poor air quality tend to have higher asthma rates.


People with allergic asthma may have more symptoms during high pollen seasons. We looked at pollen counts in each city and how they affect asthma rates.

Asthma Long-Term Control Medicine Use 

Controller medicines are used daily to prevent and control asthma symptoms. The number of controller prescriptions can mean a high amount of the city’s residents may have persistent asthma.

Asthma Quick-Relief Medicine Use

Quick-relief medicines act fast to relax asthma symptoms while they are happening. Several cities on our report have a high number of quick-relief prescriptions, meaning these cities may have a large number of residents with uncontrolled asthma.

Smoking Laws

Tobacco smoke is a common asthma trigger. Secondhand and thirdhand smoke can also make asthma worse in children and affect lung development. Increasing the number of smoke-free places is one way cities can help reduce asthma rates.

Access to Specialists

People with asthma need access to proper and affordable health care. But some cities have a lower number of asthma specialists per patient. This can mean longer wait times for appointments and a longer drive to see a doctor.

The 2019 Asthma Capitals™ report is an independent research project of the Asthma and Allergy Foundation of America made possible by Sanofi Genzyme and Regeneron.