Asthma Capitals 2021

There isn’t just one reason why some people get asthma. Several risk factors can make someone more likely to get asthma – such as heredity, exposure to tobacco smoke or harsh chemicals, or an illness. Other factors can add to that risk as well. And many of these factors depend on where a person lives.

AAFA's Asthma Capitals™ Report ranks the largest 100 U.S. metropolitan cities by how challenging they are to live in with asthma. AAFA publishes 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.

This report’s 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 pollution, pollen count, long-term controller medicine use, quick-relief medicine use, smoke-free laws, and access to asthma specialists.

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



Asthma Capitals: Full Report With Asthma Outcomes and Risk Factors


2021 Asthma Capitals – Full Report and RankingsDownload PDF

Press Release: 2021 Asthma Capitals™ ReportDownload PDF 

The COVID-19 pandemic impacted daily life in most of 2020. The pandemic influenced some changes in health outcomes and risk factors like pollen exposure, medicine use, and emergency room visits. In 2020, fewer people experienced pollen allergies due to COVID-19 restrictions, recommendations to stay indoors, and other preventative measures like mask wearing. As a result, use of long-term asthma medicines were also down along with fewer people heading to hospital emergency rooms for asthma.

Regional Trends and Asthma Belts

This report also examines regional trends found in the two “Asthma Belts” – the Ohio Valley area and the Northeast Mid-Atlantic region – and the impact of human activity and climate change in the west.

(Alaska, Hawaii, Puerto Rico, and tribal nations were not factored into this report due to a lack of data on asthma in these populations.)


Asthma Capitals 2021 regional ranking asthma belts - Northeast Mid-Atlantic Belt and Ohio Valley Belt


Northeast Mid-Atlantic Asthma Belt

This cluster extends from Massachusetts to North Carolina. Poverty, air pollution, and access to specialists are key risk factors for these cities. This is likely due to more industrial and urban populations. Asthma rates tend to be higher, especially among children, in urban locations.

This year’s top Asthma Capital is Allentown, Pennsylvania, the mid-way point in the Northeast Mid-Atlantic Asthma Belt. Allentown’s placement in the top spot is largely due to high rates of asthma-related emergency room visits. Compared to previous years, Allentown's asthma emergency room rate has been increasing steadily.

Ohio Valley Asthma Belt

Three Ohio cities are in the top 20 of our report – Cleveland, Dayton, and Columbus. Nearby, Detroit, Michigan, and Louisville, Kentucky, appear in this “Asthma Belt.” With so much of this region facing poor outcomes, asthma appears to be a widespread concern.  Poverty, air pollution, and high numbers of medicine use are the key risk factors that have placed these cities at the top of our report.

Asthma in the West

Two western cities are now in the top 20 − Tucson, Arizona (#10), and Fresno, California (#19). There has been an increase in wildfires and air pollution in the west. In 2020, both cities had high rates of asthma-related deaths, and Fresno had high rates of asthma-related emergency room visits. High pollen levels and poor air quality contributed to these outcomes.


What Can Be Done?

Reduced asthma rates and deaths are possible. This report shows where we can focus our efforts for healthier environments and communities. Researchers, health care providers, federal and state policy makers, and local stakeholders all must work together to improve local communities and make asthma care more widely available. View our report to see specific actions that can be taken to help the more than 25 million Americans with asthma.


The 2021 Asthma Capitals™ report is an independent research project of the Asthma and Allergy Foundation of America made possible in part by support from the Pharmaceutical Care Management Association (PCMA) Foundation.