Our report looks at the 100 most challenging places to live with asthma. Download our full report to see where each city ranks for asthma outcomes (prevalence, asthma-related ER visits and mortality). The report also reviews eight risk factors that impact asthma

20. Winston-Salem, North Carolina

This traditional Southern town made the top 20 for its higher-than-average rate of asthma-related emergency room visits. Poverty and uninsured residents, as well as long-term controller medicine use, are behind Winston-Salem’s placement on our list. It is known for having a young population due to a large number of college students – a group that usually has a lower income and is less likely to have insurance.

19. Baltimore, Maryland

The birthplace of “The Star-Spangled Banner” is also home to high asthma-related emergency rooms visits. The city’s high poverty rate is the leading contributing risk factor. According to the Centers for Disease Control and Prevention (CDC), people living below the poverty level are more likely to have asthma than those above it.

18. Cincinnati, Ohio

High ozone and particle pollution affect the quality of Cincinnati’s air, driving up asthma rates. This city on the bank of the Ohio River is an Asthma Capital due to above-average asthma-related emergency room visits. According to our findings, Cincinnati also has a high number of asthma medicine prescriptions in the area.

17. St. Louis, Missouri

High pollen counts and poor air quality contribute to the high rate of asthma deaths among St. Louis residents. One study has even narrowed down the highest childhood asthma rates to five zip codes in St. Louis. These zip codes are home mostly to low-income and black residents – two groups with high asthma rates overall.

16. Columbus, Ohio

Columbus joins four other Ohio cities in the top 20 and is part of the Ohio Valley “Asthma Belt.” It’s high on the list for higher-than-average emergency room visits. It is high in four asthma risk factors: poverty, pollen, quick-relief medicine use and long-term controller medicine use.

15. Jackson, Mississippi

The most populated city in Mississippi is also one of the highest in the nation for asthma mortality. Almost all the asthma risk factors are working against Jackson’s residents: poverty, lack of health insurance, high pollen, high quick-relief medicine use and high long-term controller medicine use. Jackson also came in at #2 on our 2019 Allergy Capitals report.

14. Akron, Ohio

Akron is #14 on our Asthma Capitals list due to higher-than-average emergency room visits for asthma. Asthma long-term control and quick-relief medicine use is high in Akron, partly due to high pollen counts. Five Ohio cities made the top 20 of our report, revealing that asthma is a widespread issue in the entire state from a damaging mix of poverty, pollen and poor air quality.

13. Hartford, Connecticut

One of the oldest cities in America is also one of the most challenging places to live with asthma, as seen by its high asthma prevalence and asthma-related emergency department visits. Hartford’s residents with asthma face high pollen. Pollen can trigger asthma symptoms in people with allergic asthma. Even though Hartford is #13 overall on our Asthma Capitals report, it ties with New Haven, Connecticut and Springfield, Massachusetts for high estimates of people affected by pollen.

12. Richmond, Virginia

Richmond is #12 on our Asthma Capitals list for high asthma-related death and emergency room visits. The city’s high poverty rate is a factor. Low-income families may face poorly maintained rental housing, urban locations with high pollution and lack of resources to pay for proper care.

11. New Haven, Connecticut

This coastal city in Connecticut comes in at #11 because of its high asthma prevalence. New Haven’s residents have high usage of both long-term control and quick-relief asthma medicines. This is connected to very high pollen counts and poor air quality. New Haven tied with Springfield, Massachusetts, and Hartford, Connecticut, for having the highest estimates of people affected by pollen.

10. Milwaukee, Wisconsin

This Midwestern city on the shore of Lake Michigan made our list for a high number of asthma-related emergency room visits. This is likely related to its 19.1% poverty rate. Many residents also have high rates of controller and quick-relief medicine use.

9. Omaha, Nebraska

The furthest west location of our top 20 Asthma Capitals, Omaha made the list for its high number of emergency room visits and death rate. Our report found a high number of asthma medicine prescriptions. In the area, rates of asthma are highest among black and Hispanic children in low-income households – groups that see a higher occurrence of asthma across the U.S.

8. Boston, Massachusetts

Boston’s asthma-related rates for emergency room visits are average, yet it is still one of the highest on our list for asthma prevalence and deaths. Like other cities on our report, poverty is a risk factor for Boston. And residents with allergic asthma may feel the effects of the city’s high pollen count.

7. Louisville, Kentucky

High pollen and air quality play into Louisville’s ranking. The city has some of the worst air quality in the country. But officials are aware of its high asthma rate, so they are taking action. Through a program run by AIR Louisville, they use GPS health sensors attached to inhalers to track medicine use and find ways to improve air quality.

6. Allentown, Pennsylvania

High asthma prevalence and higher-than-average emergency room visits puts Allentown at #6 on Asthma Capitals. Risk factors affecting these asthma outcomes include a high estimate of people affected by pollen, access to fewer asthma specialists and few smoking laws. Poor air quality also plays a role. Lehigh County, where Allentown is located, scored a D for ozone pollution on the American Lung Association’s 2019 “State of the Air” report.

5. Cleveland, Ohio

With a worse-than-average rate of asthma-related emergency room visits, Cleveland lands at #5. With a high poverty rate of 11.8% combined with poor air quality, it’s no surprising 9% of Cleveland’s residents have asthma. Cleveland ranks #6 in the U.S. for a high rate of quick-relief asthma medicine use, showing that many residents may have uncontrolled asthma.

4. Philadelphia, Pennsylvania

The sixth largest city in the U.S. is our #4 Asthma Capital because of high asthma prevalence, a high number of emergency room visits and a high number of asthma fatalities. Considered one of the nation’s poorest cities, poverty is no doubt the top risk factor in Philadelphia’s asthma rates. Poor air quality also makes managing asthma in Philadelphia a challenge, due to the area’s high ozone and amount of airborne particle pollution.

3. Greensboro, North Carolina

Many people in Greensboro frequent the emergency room for their asthma, placing this Southern city in the #3 spot. A high number of uninsured and fewer asthma specialists have dealt the area a double blow. These factors all reveal that many of the people with asthma in the area aren’t getting the proper treatment to keep their asthma under control.

2. Dayton, Ohio

Dayton is the sixth largest city in Ohio, but it ranks the highest of the Ohio cities on our list coming in as the #2 Asthma Capital in the nation. The “Birthplace of Aviation” has a high rate of asthma among its residents, as seen by the high number of quick-relief and long-term controller medicine prescribed in the area.

1. Springfield, Massachusetts

Known as “The City of Firsts” for being the birthplace of many innovations, Springfield is also first on our list as the top Asthma Capital for the second year in a row. The area has the second highest number of asthma-related emergency room visits in the U.S., as well as a high rate of asthma prevalence overall. High pollen counts are also a big factor for Springfield’s residents with asthma, especially those with allergic asthma.