For people living with chronic obstructive pulmonary disease (COPD), everyday life can be difficult. COPD is a group of progressive lung diseases, including emphysema and chronic bronchitis. About 30 million Americans have COPD, and more than half are unaware of it.

You may know that smoking and genetic factors increase the risk of COPD, but your environment plays a big role, as well. Where and how you live can greatly impact the severity of your COPD symptoms.

Because COPD directly affects your ability to breathe well, good air quality is extremely important.

If you have COPD, learn more about the environmental risk factors and the best places you can live (and breathe) your best life.

Extended exposure to irritants and pollutants can increase your risk of COPD. It can also worsen symptoms if you already have it.

Tobacco smoke is the most significant risk factor for COPD. Long-term cigarette smokers face the highest risk. But people who have continued exposure to large amounts of secondhand smoke are also at increased risk of COPD.

Other environmental risk factors for COPD include long-term exposure to:

  • chemical fumes, vapors, and dust in the workplace
  • burning fuel fumes, such as from gas used for cooking and heating, paired with poor ventilation
  • air pollution

In a nutshell, what you breathe affects your risk of COPD. The fewer pollutants and particulate matter, the better.

Understandably, the best places to live for people with COPD are those with good air quality. Today, many cities around the world have elevated levels of air pollution — some to the point of danger.

On the flip side, some cities are leading the way in clear air. These places make great homes for those living with COPD.

According to the American Lung Association’s State of the Air report for 2018, these are the top-ranked cleanest cities in the United States:

  1. Cheyenne, Wyoming
  2. Urban Honolulu, Hawaii
  3. Casper, Wyoming
  4. Bismarck, North Dakota
  5. Kahului-Wailuku-Lahaina, Hawaii (tied)
  6. Pueblo-Cañon City, Colorado
  7. Elmira-Corning, New York
  8. Palm Bay-Melbourne-Titusville, Florida
  9. Sierra Vista-Douglas, Arizona (tied)
  10. Wenatchee, Washington

Besides air quality, climate and access to doctors are also important factors when choosing a COPD-friendly place, says Dr. Harlan Weinberg, medical director of pulmonary medicine and critical care services at Northern Westchester Hospital.

“The best climate to live in with COPD would be an area that avoids temperature extremes. Try to find an area that is cool, dry, with low humidity, and that has good medical resources and care for COPD.”

There are some cities around the world that are notorious for their polluted air. These places are often industrial centers with large populations and weak environmental regulations.

In the United States, the American Lung Association’s most polluted areas for 2018 include:

  1. Fairbanks, Alaska
  2. Visalia-Porterville-Hanford, California
  3. Bakersfield, California
  4. Los Angeles-Long Beach, California
  5. Fresno-Madera, California
  6. Modesto-Merced, California
  7. El Centro, California
  8. Lancaster, Pennsylvania

8. Pittsburgh-New Castle-Weirton, Pennsylvania-Ohio-West Virginia (tied)

10. Cleveland-Akron-Canton, Ohio

10. San Jose-San Francisco-Oakland, California (tied)

Birmingham, Alabama was named worst city to live in with COPD by the Lung Institute in 2016. This list factored in not only air pollution, but also the number of hospitals and rehabilitation centers available in the cities.

Maintaining a smoke-free home is one of the most important ways you can decrease your and your family’s chances of developing COPD or worsening symptoms. There are other things you can do around your home to improve air quality, as well.

Dr. Weinberg recommends these everyday tips to help you breathe more easily in your home:

  • Avoid harsh chemical cleaners, sprays, powders.
  • Keep your home dust-free and avoid dusty areas as much as possible.
  • Use an air purifier.
  • Avoid direct contact with sick people.

Burning wax candles can also be irritating, so you should ask your doctor whether they’re safe.

“One huge thing I was doing wrong was using popular [brand] candles around the house,” says Elizabeth Wishba, who lives in Bakersfield, California and has managed COPD for more than 10 years.

“These candles are made with petroleum-based wax and scents…very bad for COPD, asthma sufferers. I started making my own soy candles with essential oils and selling them online. Now I can still enjoy candles without the effects that worsen my symptoms.”

Because COPD can go undetected, it’s important to know early signs of the condition. Some of the most common COPD symptoms to be on the watch for are:

  • breathlessness, shortness of breath, or difficulty breathing, especially during physical activity
  • wheezing
  • tightness in the chest
  • chronic cough with or without mucus
  • needing to clear your throat in the morning because of excess mucus in your lungs
  • frequent respiratory infections
  • blueness of the lips or fingernail beds
  • lack of energy
  • weight loss, especially in later stages of the condition
  • swelling in the ankles, feet, or legs

COPD can cause an ongoing cough and it may hardly limit your activity levels. In more serious cases, you may need to use an oxygen tank and experience significant changes to your quality of life.

There isn’t a cure for COPD, but you can slow its progression and ease symptoms. Living in cities that make clear air a priority and maintaining a smoke-free home without pollutants are the best ways to make the most of a life with COPD.