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2018 Asthma Capitals™ Report Ranks the Most Challenging Cities in the U.S. for Asthma

Asthma and Allergy Foundation of America   (AAFA)

May 1, 2018

Today, on World Asthma Day, the Asthma and Allergy Foundation of America (AAFA), a leading patient advocacy organization in the United States representing more than 60 million Americans with asthma or allergies, released its 2018 Asthma Capitals™ report. The report identifies the 100 most challenging places to live with asthma in the U.S.

Springfield, Massachusetts, is the most challenging place in the U.S. to live with asthma. It ranked #1 for its high asthma prevalence and high number of asthma-related emergency room visits. The top 20 Asthma Capitals include:

1. Springfield, Massachusetts

2. Richmond, Virginia

3. Dayton, Ohio

4. Philadelphia, Pennsylvania

5. Louisville, Kentucky

6. Cincinnati, Ohio

7. Youngstown, Ohio

8. Birmingham, Alabama

9. Greensboro, North Carolina

10. Toledo, Ohio

11. Boston, Massachusetts

12. Worcester, Massachusetts*

12. Omaha, Nebraska*

14. Milwaukee, Wisconsin

15. Cleveland, Ohio

16. Detroit, Michigan

17. Winston-Salem, North Carolina

18. Akron, Ohio

19. Hartford, Connecticut

20. New York, New York *Tied

To view the complete list of the top 100 cities, visit The 2018 Asthma Capitals™ report is an independent research project of AAFA made possible by Sanofi Genzyme and Regeneron.

Cities are ranked based on asthma-related health outcomes: prevalence, emergency room visits and mortality. The report also looks at risk factors that contribute to these outcomes, including poverty, air quality, access to specialists, pollen counts, medicine use, tobacco policies and the rate of uninsured residents.

“Warmer temperatures from climate change are increasing ground-level ozone levels, especially in more urban, industrialized areas,” says Kenneth Mendez, President and CEO of AAFA. “This, combined with a lack of policies to protect those with asthma living in poorly maintained rental housing and inadequate health care, creates a perfect storm of asthma prevalence. We’ve seen ways communities can make changes to help asthma patients. This report shows us where we can focus to provide solutions to improve the health and quality of life in urban areas for asthma patients.”

“Asthma Belts” Identified

The report uncovered two distinct patterns, or “Asthma Belts,” that emerge when the top 20 cities are plotted on a map – one in the Ohio-Lake Erie area and the other along the Northeast Mid-Atlantic coast. Seventeen of the top 20 cities on our report fell into these two areas.

“The most eye-opening result from this report is the evidence that we have ‘Asthma Belts’ in our nation,” says Melanie Carver, Vice President of Community Health and Services for AAFA. “These patterns indicate that further examination of these areas is needed on local, state and possibly even federal levels to improve asthma outcomes.”

Educating families who manage asthma – especially those who are at high risk for poor asthma outcomes – is one approach to reducing rates and morbidity in these areas. Each year, AAFA declares May to be National Asthma and Allergy Awareness Month, and a perfect time to educate families about managing asthma.

A proper treatment plan can also improve asthma outcomes. Those with uncontrolled asthma are encouraged to see a board-certified allergist or pulmonologist who can help them manage the disease.

“Although asthma is a lifelong disease, you and your provider will work out an individualized plan to ensure that your asthma is well-controlled while maintaining your current quality of life,” says Kasey Strothman, M.D. and assistant professor of Pediatrics in the Section of Allergy and Immunology Nationwide Children’s Hospital in Columbus, Ohio. “There are certainly challenges which vary from person to person, but your day-to-day actions can make a big impact on your overall health. These include consistent use of your controller medications, avoidance of known triggers and regular follow-ups with your doctor to discuss how your asthma is doing and make changes to your therapy. Pay attention to your symptoms, treat flares early and work on strategies with your doctor to find a plan that works for you and your life.”

About the Research

The Asthma Capitals™ ranking is an annual research and educational project of AAFA, designed to help patients recognize, prevent and manage asthma symptoms. Through this ranking, AAFA raises awareness about the impact of asthma and highlights how communities can make improvements to better serve their residents and visitors with asthma. The ranking is based on asthma prevalence, emergency room visits and mortality rates. The report also looks at risk factors, including poverty, air quality and access to specialists. Visit to see the full list of 100 cities, methodology and to learn more about asthma management.

About AAFA

Founded in 1953 and celebrating 65 years of service, AAFA is the oldest and largest non-profit patient organization dedicated to improving the quality of life for people with asthma, allergies and related conditions through research, education, advocacy and support. AAFA provides practical information and community-based services through its digital communities and national network of local chapters and educational support groups. Through its Kids With Food Allergies division, AAFA offers the most extensive online support community for families raising children with food allergies. AAFA also helps consumers identify products suitable for those with asthma and allergies through the asthma & allergy friendly® Certification Program. For more information, visit 

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