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Where to Live

Reviewed by: HU Medical Review Board | Last reviewed: December 2023

When you have asthma, where you live can make life easier or harder. You may want to learn what locations are the best and worst for asthma triggers. In fact, you might want to consider relocating to improve your symptoms.1,2

Of course, moving is not an option for some people. Even so, you can create an action plan to lessen the impact of triggers in your area.2

What makes a location better or worse?

The more pollen, air pollution, and mold an area has, the worse life can be for you if you have asthma.1-4

Plants like ragweed, pollen-producing trees, and grasses are all culprits. Cigarette smoke of any kind, car exhaust, and industry emissions create air pollution (particles and ozone), which can also activate asthma. And mold spores produced by fallen leaves or dampness often add to the problem. Living near these substances can make it harder for you to control your asthma symptoms.1-4

Weather and climate change can also provoke asthma. Across the country, climate change has led to a cycle. First, higher temperatures lengthen the growing season, increasing pollen counts. Those temperatures also mean worsening weather patterns. Severe weather causes more air pollution and pollen production. This leads to more carbon dioxide in the air, which leads to even more pollen.1,2,4

Other location-specific conditions may increase your chances of asthma-trigger exposure. Wildfires create long-lasting, far-reaching air pollution. Floods leave behind large areas of dampness and mold, both inside and outside of homes.1

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Finally, big cities can be several degrees hotter, with higher pollen counts and far more air pollution. This tends to greatly affect children and older adults. Urban areas may also expose you to more respiratory viruses, which can lead to severe asthma attacks.1,2,5

What else matters?

Asthma triggers are not the only concerns related to asthma-friendly locations. Other keys to controlling symptoms are the availability of medical specialists and properly used asthma drugs. Professional medical advice can also aid you in creating a plan for handling attacks.1,2

What are some of the most hazardous cities?

The Asthma and Allergy Foundation of America (AAFA) published a helpful 2023 report. In it, they listed the 100 most difficult cities for asthmatics based on 3 factors. The rankings considered numbers of people with asthma, asthma-related deaths, and asthma-related emergency department visits.1

Here are the top 5:1

  • Allentown, PA
  • Lakeland, FL
  • Charleston, SC
  • Cleveland, OH
  • Detroit, MI

Since allergic asthma is common, the AAFA also published a list of the worst cities for allergic triggers. This list was based on pollen count, asthma drug use, and availability of medical specialists.2

The top 5 worst cities are:2

  • Wichita, KS
  • Dallas, TX
  • Scranton, PA
  • Oklahoma City, OK
  • Tulsa, OK

The American Lung Association’s State of the Air 2023 report highlighted cities with the worst particle and ozone pollution.6

The top 5 are:6

  • Los Angeles, CA
  • Bakersfield, CA
  • Visalia, CA
  • Fresno-Madera-Handford, CA
  • Phoenix-Mesa, AZ

What are the most beneficial cities?

The State of the Air 2023 report also published a list of the cleanest cities. This was based on the lowest particle count and ozone level. You could be less exposed to asthma triggers in these places.6

The top 5 with the lowest particle counts are:6

  • Kahului-Wailuku-Lahaina, HI
  • Urban Honolulu, HI
  • Cheyenne, WY
  • Wilmington, NC
  • Bangor, ME

The top 5 with the lowest ozone level are:6

  • Albany-Schenectady, NY
  • Asheville-Marion-Brevard, NC
  • Bangor, ME
  • Bellingham, WA
  • Blacksburg-Christiansburg, VA

What if relocating is not an option?

Maybe you cannot relocate to an asthma-friendly location. But you can take steps that may reduce your exposure to triggers both inside and outside.2

First, try to avoid places where you might catch a respiratory virus, such as hospitals and crowds. Viruses account for 50 percent of asthma attacks in children and 80 percent of attacks in adults.1

Second, do what you can to minimize your exposure to pollen and air pollution:1,2

  • Wear a mask on high pollen and low air quality days (see for daily numbers).
  • When you come inside, get rid of pollen from your clothes, body, and pets.
  • Use a special allergen filter in your vacuum and air vents.
  • Use a nasal rinse to clean your nose.
  • Find certified asthma-friendly products at
  • Stay away from tobacco smoke of any kind.

Finally, find an asthma specialist and create an action plan for daily asthma control and asthma attack control. Learn to use recommended drugs for short- and long-term relief.1

What’s the bottom line?

Some geographic locations can be asthma-friendly, while others are not. If possible, you may want to consider living in one of the best-ranked cities. For a complete list of those cities, see the American Lung Association’s State of the Air report. But even if relocating is not possible, you can minimize your exposure to asthma triggers. With understanding and a plan, you may be able to lessen flare-ups and attacks.1,2,6