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Asthma Pictures Slideshow: 10 Worst Cities for Asthma

Did Your City Make the List?

If you have asthma, where you live can make a difference. Air pollution, secondhand smoke, and pollen are common triggers of asthma attacks. While there are no asthma-free cities, some are harder places to live with and control asthma. Each year, the Asthma and Allergy Foundation of America ranks the most challenging among the 100 largest U.S. cities. Here are its Top 10 "Asthma Capitals" for 2013.

No. 10: Knoxville, Tenn.

Like other cities across the South and Southwest, Knoxville has been one of the toughest for people with asthma year after year. But it has improved from its No. 3 spot in 2012. The city does have a good number of asthma doctors, but use of asthma medicines is low. It doesn't help that there's poor air quality and the state still allows smoking in restaurants and bars.

No. 9: Atlanta, Ga.

Poor air quality and lagging smoke-free laws are part of Atlanta's asthma problem. Atlanta also has fewer asthma doctors and more people without health insurance than the average American city. Both make it a challenge to get proper care. Statewide, more than half of Georgia's children and three-fourths of its adults with asthma have never received a treatment "action plan" from their doctor.

No. 8: McAllen, Texas

In this border town just a few miles from the Rio Grande, a big problem is access to treatment. Compared with other cities, McAllen has more people without insurance who need "rescue" medicines for asthma that isn't well controlled. That's partly because McAllen is one of the lowest-income cities in the country. High poverty is linked to higher rates of asthma.

No. 7: Dayton, Ohio

In Ohio, about 1 in 5 low income children has asthma, and emergency room visits for asthma are high. The state's asthma control program trains coaches and P.E. teachers about exercise-induced asthma. It also helped pass the state's smoke-free workplace act. Since then, hospital visits for asthma have gone down in children under age 5 -- the most likely group to have asthma attacks.

No. 6: Detroit, Mich.

In the U.S., about 9% of children have asthma. In Detroit, twice that many do, and 7% to 10% more most likely have asthma and don't know it. The city also has high levels of adult asthma. Poverty plays a big part in Detroit's asthma problem. About 70% of public school children are low income. The American Lung Association and the Detroit Alliance Against Asthma are working with public schools to boost knowledge of asthma and how to manage it.

No. 5: Oklahoma City, Okla.

Oklahoma's capital is climbing the list of worst asthma cities. Asthma affects 1 in 13 children in Oklahoma and is the main health reason for missing school. About one-third of the state's children with asthma live in households where someone smokes, and one-third of adults with asthma are also smokers. The Oklahoma Asthma Initiative is teaching 3rd- to 6th-graders, child care workers, parents, and teachers about smoke and other triggers.

No. 4: Philadelphia, Pa.

Among the top 5 worst asthma cities, Philadelphia ranks highest in pollution, a trigger for asthma attacks. People don’t use asthma medicines well, so emergency room visits are high. Philadelphia Allies Against Asthma works in largely African-American neighborhoods where 14,000 children have asthma -- and many don't have a primary care doctor. African-Americans are three times more likely than whites to be hospitalized and die of asthma in the U.S.

No. 3: Memphis, Tenn.

This Mississippi River town has many people with asthma singing the blues. Memphis topped the chart last year and hit No. 3 this year -- partly because of weak smoking laws, poor air quality, low use of asthma control medicines, and a high rate of asthma deaths. Nationally, asthma causes more than 3,300 deaths each year. Many of these are avoidable with proper care and treatment.

No. 2: Chattanooga, Tenn.

A beautiful riverfront park and nearby mountains draw tourists to Chattanooga. But if you have asthma, you might want to bring along your medicine. Poor air quality, pollen, and too few asthma doctors help make it one of the worst asthma cities. With Memphis and Knoxville also on the top 10 list, banning smoking in bars and restaurants throughout Tennessee could help.

No. 1: Richmond, Va.

The capital of Virginia is also the asthma capital of the nation, climbing back up from No. 23 last year. The city has high levels of year-round pollen and poverty, and too many people don't have health insurance. But a smoking ban and more asthma doctors could help bring down emergency room visits. Until the city takes more action, it's the hardest place to live for people trying to get control of their asthma.

Brighter Spots for Asthma

Of the 100 cities ranked, these 10 are the best. For the most part, they have cleaner air and better-than-average smoking bans, school-inhaler access laws, and use of asthma medicines.

10. Raleigh, N.C.
9. Des Moines, Iowa
8. Austin, Texas
7. Albuquerque, N.M.
6. Cape Coral, Fla.
5. Portland, Ore.
4. Palm Bay, Fla.
3. Boise, Idaho
2. Seattle, Wash.
1. San Francisco, Calif.

Reviewed by Michael W. Smith, MD on Thursday, June 13, 2013

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