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Asthma Capitals

Asthma is greatly influenced by where someone lives. People who have affordable and accessible health care, clean air, and economic stability have a greater chance of managing and controlling their asthma. AAFA’s Asthma Capitals™ Report ranks the largest 100 cities in the continental U.S. by how challenging they are to live in when you have asthma. AAFA publishes this report to show the nationwide burden of asthma. It is a call to action to help the 25 million people in the U.S. with asthma.

The Asthma Capitals report ranking is based on three weighted outcomes: asthma prevalence, asthma-related emergency room visits, and asthma-related deaths.

The report also analyzes factors that can influence asthma outcomes: poverty, lack of health insurance, air pollution, pollen count, medicine use, smoking, and access to asthma specialists.

This year’s report has been release during Asthma Peak Week to raise awareness of the spike in asthma-related attacks and hospitalizations that happen each September. People with asthma are exposed to several triggers at once during September, such as:

  • Higher ragweed pollen
  • Higher mold counts
  • The beginning of cold and flu season
  • Poor indoor air quality in schools
  • Wildfire-related air pollution

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

Our report looks at how challenging it is to live with asthma in the top 100 U.S. continental cities. Download our full report to see where each city ranks for asthma outcomes (prevalence, asthma-related emergency room visits, and mortality). The report also reviews factors that impact asthma.

20. Rochester, New York

Rochester rounds out the top 20 Asthma Capitals due to its high asthma prevalence rate. Rochester has the highest rate of quick-relief medicine use and the second-highest rate of asthma controller medicine use. Both control and quick-relief medicines may be necessary for optimal asthma management. But frequent use of quick-relief medicine can indicate there is a high number of asthma episodes and lack of asthma control.

19. Toledo, Ohio

Toledo is the #19 Asthma Capital due to its high rate of asthma prevalence and asthma-related emergency room visits. Toledo is impacted by multiple risk factors, including a high poverty rate, high ozone levels, and a low asthma specialist-to-patient ratio. These factors can result in poor asthma outcomes and may contribute to the city’s high rates of asthma medicine use.

18. Greenville, South Carolina

Greenville is the #18 Asthma Capital due to its high asthma prevalence rate. The city also has high use of asthma controller medicine. Asthma controller medicines are prescribed for persistent cases of asthma and may be needed for proper asthma management. But a high number of these prescriptions may reveal that a city’s residents have more severe or uncontrolled cases of asthma.

17. Louisville, Kentucky

Louisville ranks at #17 on our list due to its high rates of asthma prevalence and asthma-related emergency room visits. The city is also impacted by poor air quality, including a high number of high-ozone days. Programs like AIR Louisville, which uses GPS health sensors attached to inhalers, are working to track medicine use and find ways to improve air quality.

16. Albany, New York

Albany enters the top 20 of the 2022 Asthma Capitals at #16. The city has a high rate of asthma prevalence – the second highest of all 100 cities in the report. High annual pollen scores and a low asthma specialist-to-patient ratio are risk factors that impact the city.

15. Orlando, Florida

Orlando joins Lakeland and Cape Coral as one of the three Florida cities in this year’s top 20 Asthma Capitals. Orlando ranks at #15 due to its high asthma prevalence rate. Similar to Lakeland and Cape Coral, Orlando has a high uninsured population, which can be a barrier to getting needed asthma care.

14. St. Louis, Missouri

The Gateway to the West is this year’s #14 Asthma Capital. The city has high rates of asthma-related emergency room visits and deaths. In fact, St. Louis has the highest rate of asthma-related deaths for all 100 cities included in the report. A high rate of its population also lives below the poverty threshold and suffers from poor air quality and high levels of springtime pollen.

13. Cape Coral, Florida

Cape Coral is the #13 Asthma Capital due to its high rates of asthma prevalence and asthma-related emergency room visits. More than 19% of Lee County (home to Cape Coral) residents are uninsured. For people managing a chronic condition like asthma that requires medicine year-round, having insurance is often a big help. Florida is one of 12 states that has not expanded access to Medicaid under the Affordable Care Act.

12. Richmond, Virginia

Richmond is #12 on our Asthma Capitals list for high asthma-related deaths 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. Richmond also has the highest springtime pollen score, which can make asthma worse for people with allergic asthma living in the area.

11. Columbus, Ohio

Columbus joins two other Ohio cities in the top 20 and is part of the Ohio Valley “Asthma Belt.” It is #11 on the list for higher-than-average rates for asthma prevalence and emergency room visits. In fact, Columbus has the third-highest rate of asthma-related emergency room visits. Columbus also has higher-than-average scores for asthma medicine use.

10. Baltimore, Maryland

The birthplace of “The Star-Spangled Banner” is also home to high rates of asthma prevalence and asthma-related deaths. Baltimore has the second-highest rate of asthma-related deaths in the country. 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.

9. Philadelphia, Pennsylvania

The seventh largest city in the U.S. is our #9 Asthma Capital because of a high rate of asthma prevalence and a high number of asthma deaths. Considered one of the nation’s poorest cities, poverty is no doubt the top risk factor in Philadelphia’s asthma rates. High ozone and high levels of spring pollen can make asthma symptoms in the city even worse.

8. Poughkeepsie, New York

Poughkeepsie is the #8 Asthma Capital for 2022. Poughkeepsie’s rank is largely due to its high rate of asthma prevalence. The city has the single highest rate of asthma prevalence of all 100 cities included in the report. High levels of springtime pollen and a low asthma specialist-to-patient ratio can make it hard to manage asthma symptoms. Poughkeepsie also does not collect air quality information for small particle pollution. This information is important for residents to monitor air quality and make informed decisions about how to avoid exposure to outdoor pollutants.

7. Harrisburg, Pennsylvania

Harrisburg is new to this year’s top 20 and is the #7 Asthma Capital for 2022. This is due to its high rates of asthma prevalence and asthma-related deaths. In fact, Harrisburg has the sixth-highest asthma prevalence of all 100 cities included in the report. Its high use of asthma medicines implies its population may have a high number of cases of uncontrolled asthma. Heavy particle pollution and few smoking laws may contribute to the city’s asthma outcomes.

6. Charleston, South Carolina

Charleston is new to the top 20 in the 2022 Asthma Capitals report. Its place at #6 is due to the city’s high rates for asthma prevalence and asthma-related emergency room visits. High rates of emergency room visits are a sign of poor asthma control. Effective asthma management may help reduce emergency room visits and hospitalizations.

5. Fresno, California

After making its debut in top 20 in the 2021 Asthma Capitals report, Fresno has moved up to the #5 spot in 2022. Fresno has high rates of asthma prevalence and asthma-related emergency room visits. High poverty rates and poor air quality can make it harder to manage asthma in the area. Fresno County scored an F for high ozone and particle pollution in the American Lung Association’s State of the Air Report. Also, Fresno has a low asthma specialist-to-patient ratio, which may make it harder for people with asthma to get the care they need.

4. Lakeland, Florida

Lakeland joins the top 20 of the 2022 Asthma Capitals at #4 due to its high rates of asthma prevalence and asthma-related emergency room visits. Around 16% of Polk County (home to Lakeland) residents are uninsured, and the city has one of the lowest asthma specialist-to-patient ratios. These factors may contribute to high rates of quick-relief medicine use and poor asthma outcomes.

3. Allentown, Pennsylvania

Moving down from #1 in the 2021 Asthma Capitals report, Allentown is #3 in 2022. Though receiving an average score for asthma-related deaths, Allentown has high rates of asthma prevalence and asthma-related emergency room visits. In fact, Allentown has the second-highest rate of emergency room visits among all 100 cities included in the report. Risk factors affecting these asthma outcomes include a high estimate of people affected by pollen and few smoking laws.

2. Cleveland, Ohio

Similar to Detroit, Cleveland has higher-than-average rates of asthma prevalence, asthma-related emergency room visits, and asthma-related deaths. These factors contribute to the city’s rank as the #2 Asthma Capital. Cleveland’s high poverty rate and high levels of ozone contribute to poor asthma outcomes. Cleveland also has the eighth highest rate of quick-relief medicine use, showing that many residents may have uncontrolled asthma.

1. Detroit, Michigan

Nicknamed “Motor City” for its history at the heart of the automotive industry, Detroit is our #1 Asthma Capital due to its high rates of asthma prevalence, asthma-related emergency room visits, and asthma-related deaths. Detroit has the third-highest asthma prevalence of all cities analyzed, the eighth-highest mortality rate, and is among the top 25 cities for asthma-related emergency room visits. High poverty rates and poor air quality are risk factors for Detroit.

Asthma Capitals: Full Report With Asthma Outcomes and Risk Factors

Focus on Health Equity

The results of the Asthma Capitals report continue to highlight the ongoing health disparities related to asthma prevalence, health care use, and mortality.

Earlier in 2022, AAFA launched its Health Equity Advancement and Leadership (HEAL) program. The purpose of HEAL is to address findings from our Asthma Disparities in America report. The HEAL program reinforces AAFA’s commitment to reducing health disparities in communities that bear the heaviest burden of asthma.

Each year, HEAL Innovation awards funding and resources to four local pilot programs tailored to at-risk populations most impacted by asthma. In the first year of the program, AAFA is funding programs in several Asthma Capitals including Chicago (#28), Detroit (#1), Los Angeles (#62), and St. Louis (#14). The focus of these four programs will be on adults and teens with asthma. The Asthma Capitals report profiles our work to improve asthma outcomes in these communities.

The report also highlights AAFA’s support of programs in New York dedicated to addressing asthma disparities. AAFA is funding a community health pilot program by AIRnyc to connect households managing asthma with health education, health care, and social programs. Read more about these programs and more in the report.

Download PDFs

2022 Asthma Capitals – Full Report and Rankings

Press Release: 2022 Asthma Capitals™ Report

How Can We Improve Asthma Outcomes?

It is possible to reduce asthma rates and deaths. 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 2022 Asthma Capitals™ report is an independent research project of the Asthma and Allergy Foundation of America and made possible by support from Sanofi and Regeneron.

Asthma Disparities Report
View Full Report

AAFA's Commitment to Racial Justice

Over the past 15 years, there have been moderate advances in U.S. public policy, health care and research, but racial gaps in asthma outcomes have not changed. Minority groups continue to bear disproportionate hardship in managing asthma.

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