Managing asthma can be a challenge. For many people, asthma triggers exist both inside the home and outside. Where you live can affect the frequency and severity of asthma attacks.

There is no perfect community free of triggers for people with asthma, but understanding environmental risk factors can help you to develop a plan to minimize your exposure. You can take steps to manage the condition and live a healthy and happy life wherever you may be.

Understanding asthma

Asthma is a lung disease. It causes inflammation of the airways that carry air to and from your lungs. As a result of inflammation, your airways tighten. This makes it harder for you to breathe. Some serious symptoms of asthma include shortness of breath, chest tightness, wheezing, and coughing.

Some people with asthma have symptoms almost all of the time. Others only have symptoms in response to certain triggers, such as exercise, cold air, or allergens. Poor air quality, caused by air pollution or high pollen counts, can make asthma symptoms worse.

If environmental factors affect your asthma, it may be difficult to spend quality time outside. You may feel isolated and miss time at work or school. For children, asthma can interrupt their learning and chance to participate in activities. In the U.S., 10.5 million school days were missed in 2013 because of asthma, according to the U.S. Environmental Protection Agency (EPA).

Possible causes of asthma

Most people with asthma developed the condition as children. Scientists don’t know the exact cause of asthma, but they think there may be a connection to infections or contact with allergens in early life.

Usually, a family history of asthma or allergies increases the risk. There is no cure, but people living with asthma typically use a combination of lifestyle modifications and medications to reduce exposure to or the consequences of asthma triggers.

Ranking cities for people who live with asthma

Because of the connection between the environment and asthma, some organizations attempt to rank certain cities or regions as being favorable or not for those living with asthma. For example, the Asthma and Allergy Foundation of America (AAFA) looked at the largest 100 urban centers in the U.S. to create a list of the most challenging cities to live in with asthma. The AFAA examined 13 separate factors, including occurrence of asthma, healthcare visits, and environmental factors.

The most recent list is from 2015. In that list, the AAFA noted that these were the five most challenging cities for people with asthma:

  • Memphis, Tennessee
  • Richmond, Virginia
  • Philadelphia, Pennsylvania
  • Detroit, Michigan
  • Oklahoma City, Oklahoma

Out of the AAFA’s 100-city list, some cities had better conditions for people living with asthma, such as strong antismoking laws and lower-than-average pollen counts. The cities that fared best include:

  • San Francisco, California
  • Boise, Idaho
  • Seattle, Washington
  • San Jose, California
  • Abilene, Texas

However, the AAFA’s list is limited because it only looked at the 100 largest cities. In general, dense, urban centers can be challenging for some people with asthma due to higher levels of air pollution from traffic and other sources.

What’s more, your individual experience of asthma won’t be exactly like that of someone else living in your neighborhood, let alone another part of the country. In order to assess how living in a particular community might affect you, it may be more helpful to look at common triggers and how each city ranks for each one.

Air pollution

Scientists divide outdoor air pollution into ozone and particle matter. It may be hard to visualize ozone, but it’s most associated with smog. Particle pollution is from industry, like power plants and manufacturing. Vehicle exhaust and wildfires also produce particle pollution. While particle matter may be high at any time of year, ozone levels are typically worse on hot summer days.

The American Lung Association (ALA) ranked Cheyenne, Wyoming, Farmington, New Mexico, and Casper, Wyoming, as the three cleanest cities for levels of particle pollution. If you find that air pollution is a major trigger for your asthma, you might find that your symptoms improve in a city with a high clean air ranking.

On the other end of the spectrum — worst cities for air pollution — the ALA found several cities in California to be at the top of the list. Los Angeles-Long Beach, Bakersfield, and Fresno-Madera were the top three when it came to high levels of ozone. Visalia-Porterville-Hanford, Bakersfield, and Fresno-Madera topped the list for highest levels of particle pollution.

Air quality changes from day to day. You can visit the EPA’s AirNow site to get current conditions by ZIP code.

Fall and spring allergens

Pollen is challenging for people with asthma and allergies. When pollen counts go up, many people may have a more severe asthma attack. Because of the potential for this environmental trigger, even cities with low levels of air pollution may pose a hazard for those living with asthma.

The AAFA ranks allergy capitals — those areas that pose the greatest challenge to allergy and asthma sufferers — by looking at pollen counts, allergy medicine usage, and the availability of allergy medical specialists. So the foundation looks not just at the natural environment, but how people living in these areas actually manage the condition.

Jackson, Mississippi, and Memphis, Tennessee, are ranked first and second most challenging for both fall allergies and spring allergies. McAllen, Texas, is third for fall allergies, and Syracuse, New York, for spring allergies. But the individual rankings may make little difference: The top five cities for allergy challenges were the same for both spring and fall, just in a slightly different order.

To find out what allergy conditions are like in your area right now, visit Pollen.com and enter your ZIP code.

Weather

Changes in the weather can also affect asthma symptoms in some unexpected ways. Calm weather causes air pollution to build up, meaning there is more particle matter for people with asthma to contend with.

If your asthma symptoms are induced by exercise, you may find dry, cold air to pose a challenge. This type of weather causes the airways to narrow. The symptom can affect anyone with asthma, but it’s particularly hard on those whose asthma causes them to breathe through their mouth during exercise. If cold is a trigger for your asthma, you may find living in a place with long, cold winters to be more challenging.

Hot, humid weather creates a perfect environment for dust and mold. Thunderstorms may cause large amounts of pollen to be broken into smaller particles and carried in gusts of wind. If these are triggers for your asthma, living in a hot environment with high moisture levels may worsen your symptoms.

The ideal weather to keep your asthma symptoms in check, therefore, depends largely on what kind of asthma you live with.

The takeaway

People with asthma take control of their symptoms by reducing exposure to environmental triggers. Specific triggers vary between individuals. In order to find the most asthma-friendly place to live in the nation, it’s important to look at your sensitivities. Regardless of the community you choose, you can monitor pollen counts and air quality ratings, and listen to your own body to stay healthy.