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Where to Live

You are considering a move, wouldn’t you love to leave your asthma behind? Depending on where you live, your asthma symptoms may vary.

What are the best places to live with asthma?

The answer is that it depends on your triggers. There are dozens of potential asthma triggers, including allergens, weather, and pollution. Most likely, not all of them bother you, so focus on the ones that do. You may be tempted to move away from the yellow pollen that covers Atlanta in the spring or the cold winters of Minneapolis. Unfortunately, it is hard to anticipate what new triggers or allergies you may discover at your new home.

In the United States, asthma is more prevalent in the Northeast and Midwest than the South and West.1 People living in metropolitan and non-metropolitan areas are about equally likely to have asthma.1 People with asthma who live in the West and South report more asthma attacks than residents of the Midwest and Northeast.2

No matter what is outside your door, it is important to pay attention to the air quality inside. North Americans spend nearly 90% of their time indoors.3 Taking steps to limit the irritants, allergens, mold in your home can improve asthma symptoms in any zip code.

Pollen, mold, and thunderstorms

Pollen or mold allergies often cause sneezing, itchy eyes, and runny nose.4 If you are allergic to pollen and mold, your asthma and allergy symptoms will get worse during peak pollination times.4 Trees, grasses, and weeds pollinate at different times, meaning that pollen season can last from March until the first frost.5 The National Allergy Bureau reports pollen and mold counts for locations throughout the United States.

Each year, the Asthma and Allergy Foundation of America compiles a list of the “The Most Challenging Places to Live with Fall Allergies.”6 The ranking is based on pollen counts, use of allergy medication, and the number of local allergy specialists. Table 1 lists the cities at the top and bottom of the list.

Table 1. Allergies: The Best and Worst US Cities in 2014

“Best” Places to Live for People with Fall Allergies
“Worst” Places to Live for People with Fall Allergies
Greenville, SC
Louisville, KY
Spokane, WA
Wichita, KS
Portland, OR
Oklahoma City, OK
Sacramento, CA
Dayton, OH
Provo, UT
McAllen, TX

Source: Asthma and Allergy Foundation of America. Fall Allergy Capitals, 2014. Accessed 3/13/15 at:

Interestingly, asthma “outbreaks” have been linked to thunderstorms, especially during pollen season.7 The combination of moving air and rain brings pollen to the ground level and causes it to burst open into small, inhalable particles. The result is an increase the number of people who seek medical care for asthma attacks. These outbreaks are rare, but may be something worth considering before moving to subtropical climes.

Air Pollution

Ozone and particle pollution can increase airway inflammation and decreases lung function.4,8 Cities produce the most ozone, but ozone travels easily and can be found hundreds of miles away.8 The American Lung Association produces an annual report listing the cities with the most and least ozone and particle pollution (Table 2).9 You can find information about daily pollution levels in your area at Airnow.

Table 2: Air Pollution: The Cleanest and Dirtiest US Cities

Cleanest Cities
Dirtiest Cities*
Bangor, ME
Bakersfield, CA
Bismarck, ND
Fresno, CA
Cape Coral, FL
Los Angeles, CA
Salinas, CA
Visalia, CA

Listed in alphabetical order.

*Most ozone and year-round particle pollution

Source: American Lung Association. State of the air 2014. Accessed 3/13/15 at:


Cold is a common asthma trigger, and symptoms typically start when the temperatures drop to about 36°F.10 Alaska, the northernmost state, is also the coldest. The five coldest continental states are listed in Table 3.11

Table 3. The Coldest States in 2014

Year Round
Coldest Winters
Coldest Summers
North Dakota
North Dakota

Reprinted from: Osborn L. Coldest states in America.

Dust mites

Dust mites are hard to avoid. They prefer humid climates and are found in about 80% of the United States.12 You may be able to escape dust mites by moving to the deserts of the Southwest or high altitude cities.4

If moving to those places is not an option, you can take measures to reduce dust mite exposure in your own home. Cover mattresses and pillows in dust mite-proof covers. Wash your bedding in hot water or bleach each week. Use a dehumidifier. Remove carpets from the bedrooms or vacuum frequently with a HEPA vacuum.

Smoking laws

If you have a choice, choose to live in a city or county with bans on smoking in public places. Studies have shown that people who live in smoke-free counties have less second-hand smoke exposure.13 They also go to the hospital less often.14

Written by: Sarah O'Brien | Last Reviewed: May 2016.
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  11. Osborn L. Coldest states in America. Accessed 3/13/16 at:
  12. Portnoy J, Miller JD, Williams PB, et al; Joint Taskforce on Practice Parameters; Practice Parameter Workgroup. Environmental assessment and exposure control of dust mites: a practice parameter. Ann Allergy Asthma Immunol. 2013;111:465-507.
  13. Dove MS, Dockery DW, Connolly GN. Smoke-free air laws and secondhand smoke exposure among nonsmoking youth. Pediatrics. 2010;126:80-87.
  14. Kanchongkittiphon W, Mendell MJ, Gaffin JM, et al. Indoor environmental exposures and exacerbation of asthma: An update to the 2000 review by the Institute of Medicine. Environ Health Perspect. 2014 Oct 10.