Research and Reports
Asthma Capitals: Top 3 Cities
The top 3 cities in the 2025 Asthma Capitals ranking have significant asthma burden. People who live in these areas face higher risk of having asthma, asthma emergencies, or even asthma-related deaths.
Detroit, MI – #1 Asthma Capital in 2025
Detroit returns as the #1 Asthma Capitals in 2025. For the past 10 years, the city has consistently landed near the top of AAFA’s annual ranking.
Why does Detroit keep showing up at the top of AAFA’s ranking? Among the 100 city areas we analyzed for the Asthma Capitals, Detroit has:
- The 2nd asthma prevalence (rates)
- Higher than average asthma deaths
Behind these numbers are important risk factors that make asthma harder to manage in Detroit:
- High poverty rates: Nearly 1 in 3 Detroit residents live below the poverty line. For families already struggling to afford housing, food, and utilities, paying for medicines, doctor visits, and asthma-friendly products can be out of reach. Poverty may also increase exposure to poor indoor air quality, mold, pests, and other triggers that make asthma worse.
- Significant air pollution: Detroit is named as one of the most polluted cities in the country.1 Detroit’s air quality is impacted by 2 major sources—heavy vehicle traffic and industrial emissions. The city sits at the crossroads of multiple interstate highways, bringing constant exhaust exposure. It is also home to steel plants, refineries, and other factories that contribute particulate matter and ozone pollution. Together, these pollutants irritate airways, increase the risk of asthma attacks, and worsen long-term lung health.
- Health insurance: Insurance status is tied to asthma health status. People without insurance or with limited coverage may struggle to access certain services and face steep costs for routine office visits, emergency care, and medicines. Even people with insurance often have high deductibles and copays or other hurdles—such as prior authorizations or limits on medication refills—that make it harder for people with asthma to access quality care. While Detroit has relatively low rates of uninsured residents, nearly a quarter of Michigan’s population depends on Medicaid for their health care. Medicaid plays a crucial role in ensuring access to asthma medicines, specialists, and home health supports. Cuts to Medicaid funding would hit Detroit especially hard.
Community Action: The HEAL Detroit Program
AAFA’s Health Equity Advancement and Leadership (HEAL) Detroit program—led by the AAFA Michigan Chapter— delivers a holistic asthma management intervention. The program includes:
- Self-management education so people can better control their asthma
- Connections to asthma specialists and nutrition support
- Virtual home environmental assessments with certified community health workers
- Additional support like healthy food boxes, gym memberships, and Asthma & Allergy Friendly® home products
Now in its third round of funding, HEAL has expanded beyond Detroit to reach families across Michigan.
Protecting Progress in Detroit
By the end of 2025, 90 Detroit-area residents will have taken part in AAFA’s HEAL Detroit program. Most participants report high social and financial barriers—56% are on Medicaid, and 51% have household incomes below $25,000. Within just 6 months of being in the program, HEAL Detroit participants reported measurable improvements in asthma control, daily functioning, and quality of life:
- Asthma control: The number of participants with well-controlled asthma jumped from 34% at baseline to 41% at 6 months of being in the HEAL program.
- Attendance (presenteeism): Participants had more days of being healthy and doing regular activities. Consistent work and school attendance improved: at 6 months, nearly half of participants (46%) reported no missed work or school days, up from 36% at baseline.
- Less emergency care: More participants had fewer or no emergency room or unplanned healthcare visits. At 6 months, emergency room or unplanned healthcare visits decreased by 33%.
These results show how targeted investments in Detroit households are not only improving health outcomes today but also laying the groundwork for lasting community benefits. Progress that is now at risk from the following actions:
- Medicaid cuts will lead to more uninsured people. Nearly half of children with asthma are on Medicaid. Reduced funding for Medicaid could also lead to longer wait times in emergency rooms or potential hospital closures.
- Potential CDC funding cuts or program closures would affect funding for the Michigan Department of Health & Human Services (MDHHS). CDC’s National Asthma Control Program provides financial support for the MDHHS Asthma Program (Asthma Initiative of Michigan). This program improves access to medications and asthma devices (e.g. spacers), helps schools prepare for asthma emergencies, provides asthma care discharge instructions for emergency department patients, and connects individuals and families with certified asthma educators for home-based asthma case management.
- Reduced funding for health equity initiatives puts population health initiatives at risk of closing or ending.
- Environmental protection rollbacks — especially for air pollution — will expose Detroit residents to higher amounts of harmful pollutants.
Rochester, NY – #2 Asthma Capital in 2025
Rochester has climbed steadily in the Asthma Capitals rankings, landing at #2 in 2025. The city now holds the highest asthma prevalence rate of all 100 cities we studied, and for the past five years its ranking has crept higher each year.
Risk factors that affect asthma rates in Rochester:
- Lack of access to specialists
- High controller and quick-relief medicine use, which is an indication that the population has more severe or uncontrolled asthma
- Air pollution – annual airborne particle pollution was high during the period analyzed
Community Action: Supporting Kids with Asthma in Rochester Schools
Asthma weighs especially heavily on children in Rochester. Dr. Jill Halterman and her team at the University of Rochester Medical Center developed the School-Based Asthma Therapy (SBAT) program in partnership with Rochester City School District. SBAT ensures that students with asthma get their daily control medicines while at school, supervised by a nurse or health aide.2
The program has:
- Improved asthma symptoms and reduced school absences
- Lowered the need for emergency visits, especially when paired with telemedicine
- Served as a model for other districts nationwide, including New York City, Philadelphia, and Columbus
Building on its success, Rochester is now testing new components with support from the National Institutes of Health.2 These include telemedicine support for children after emergency room visits, enhanced care for teens, and stronger connections with families.
Looking Ahead: Climate and Policy Solutions
Rochester’s asthma burden is also shaped by air quality, housing, and climate change. For example, recent environmental challenges, like smoke from Canadian wildfires drifting across upstate New York, add to the asthma burden in the city.
New York State is investing heavily in clean energy and pollution reduction through the Climate Leadership and Community Protection Act, one of the most ambitious climate laws in the country. Policymakers and local advocates are exploring how these funds could improve air quality in cities like Rochester, reduce exposure to wildfire smoke, and provide resources for communities most affected by asthma.
Additionally, policymakers are currently discussing several state-level initiatives and bills, including:
- NY HEAT Act: This bill would help New York move away from old, expensive gas systems and switch to cleaner, more efficient heating.3 It would support local clean energy projects, create good-paying jobs, lower pollution, and improve air quality. These are all important for places like Rochester where many people have asthma.
- Cap-and-Invest Program: This program is still being designed. The aim is to make polluters pay for the emissions they create.4 The program is estimated to bring in around $3 billion in its first year (with some estimates as high as $5 billion. This money would go toward clean energy, safer and healthier housing, and job training, with extra support for neighborhoods that need it most.
If passed, bills like these could help address asthma by creating a healthier, cleaner, and more resilient environment in Rochester.
Allentown, PA – #3 Asthma Capital in 2025
Allentown comes in at the #3 spot in the 2025. For the past 5 years, Allentown has been in the top 3 Asthma Capitals.
Why does Allentown keep showing up at the top of AAFA’s ranking? Among the 100 cities we analyzed for the Asthma Capitals, Allentown has the:
- 4th highest asthma prevalence (rates)
- 6th highest asthma emergency department visits
Asthma is a major health concern for families across the Lehigh Valley, where Allentown is located. Allentown’s location along the busy I-78 and Route 22 corridors exposes residents to heavy traffic pollution, while nearby industrial activity adds to the burden.
Community Action: The HEAL Allentown Program
AAFA’s Health Equity Advancement and Leadership (HEAL) Allentown program—developed by the Health Promotion Council of Southeastern Pennsylvania (HPC)—uses an innovative outreach approach, working alongside the local health department and Emergency Medical Services (EMS) to serve older adults living with asthma and other chronic health conditions. The local program is called EASE Allentown (Empowering Asthma Self-Management and Education).
Community outreach to identify adults with asthma has historically been a challenge for local programs. Engaging EMS providers, who have direct access to individuals before they enter emergency care, creates a new opportunity to reduce repeat emergencies and improve long-term health outcomes. This collaboration also ensures follow-up with individuals once their immediate health crisis has improved. This approach meets people where they are at a time when they need asthma care support the most.
About the Report
AAFA publishes the Asthma Capitals™ report to raise awareness about the nationwide impacts of asthma. The report analyzes asthma data across the United States and ranks cities by the most critical of health outcomes – asthma prevalence, emergency department visits due to asthma attacks, and asthma-related mortality. The outcomes are not weighted equally. The report also examines asthma risk factors that influence the outcomes.
AAFA only evaluates the top 100 populated places (based on metropolitan statistical areas or MSAs) in the contiguous (“lower 48”) states for this report. MSAs are cities and their surrounding areas (like suburbs and nearby rural areas). The report does not reflect:
- Cities and areas not in the top 100 list by population size
- Completely rural areas that are not located within a metropolitan statistical area
- Anchorage, Alaska and Honolulu, Hawaii due to lack of matching data with other cities, counties, states
Acknowledgements
The 2025 Asthma Capitals report is an independent research project of the Asthma and Allergy Foundation of America (AAFA) and made possible by support from Amgen, AstraZeneca, Chiesi, GSK, and Sanofi and Regeneron. AAFA also thanks Komodo Health and Pollen Sense, LLC for additional support for data used in this report. The views and opinions expressed in this report are those of the AAFA authors and do not necessarily reflect the policies or positions of the sponsors or other individuals, organizations, or companies.
Recommended Citation
Asthma and Allergy Foundation of America, (2025). 2025 Asthma Capitals. Retrieved from asthmacapitals.org.
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References
1. American Lung Association. (2025). State of the Air 2025. American Lung Association. https://www.lung.org/getmedia/5d8035e5-4e86-4205-b408-865550860783/State-of-the-Air-2025.pdf
2. University of Rochester Medical Center. (n.d.). School-Based Asthma Program. Golisano Children’s Hospital. https://www.urmc.rochester.edu/childrens-hospital/our-strategic-plan/school-based-asthma-program
3. WE ACT for Environmental Justice. (n.d.). NY HEAT Act. WE ACT for Environmental Justice. https://weact.org/programs/ny-heat-act
4. Earthjustice. (2025). A robust cap-and-invest program can help New Yorkers save money on utility bills, raise billions to invest in local communities. Earthjustice. https://earthjustice.org/press/2025/a-robust-cap-and-invest-program-can-help-new-yorkers-save-money-on-utility-bills-raise-billions-to-invest-in-local-communities
