Where in the United States is it hardest for asthma sufferers to live comfortably? Which cities make living with asthma easier? Sperling's BestPlaces recently completed a study that ranks 100 U.S. metropolitan areas according to asthma prevalence and the degree to which environmental "triggers" and other factors make living with asthma a particular challenge.

Asthma is a chronic illness in the United States that has been increasing in prevalence since 1980. Many factors can trigger an asthma attack, including allergens, infections, exercise, abrupt changes in the weather, or exposure to airway irritants (such as tobacco smoke and pollution). To reflect the varying conditions that can trigger an asthma attack, a number of criteria were identified and weighted in order to determine which U.S. cities present the greatest challenge for those with asthma.

"Often, people consider only asthma prevalence or mortality rates to determine where asthma has the greatest impact," noted Sperling's BestPlaces President Bert Sperling. "But examine more data, including environmental factors that can be asthma triggers, and a more complete picture emerges."
 

The Tucson metro area, home to an estimated 95,000 people with asthma, has high asthma prevalence, asthma mortality, and few physicians in asthma-related specialties. "The dry, hot climate of the Southwest can really pose problems for those with asthma," observed Sperling. On a positive note, Tucson has a low level of ozone air pollution.
 

Home to an estimated 213,000 people with asthma, Kansas City has high pollen levels and asthma prevalence. The good news for asthmatics is that Kansas City has low levels of ozone air pollution.
 

The 372,000 asthma sufferers in Phoenix-Mesa contend with high asthma prevalence, high asthma mortality, and lax smoking laws. However, Phoenix-Mesa has low pollen levels.
 

The Fresno metro area is home to an estimated 199,000 people with asthma. Fresno has high asthma prevalence, asthma mortality, and ozone pollution. Like Phoenix, though, Fresno has particularly low pollen levels.
 

Nearly one million New Yorkers suffer from asthma, and they are faced with particularly high levels of ozone pollution. "The polluted air of large cities poses a particularly difficult challenge for those with asthma," commented Sperling. On the other hand, New York averages fewer cigarettes per person than most cities.
 

Home to an estimated 92,000 people with asthma, El Paso has high asthma prevalence, lax smoking laws, and an extreme climate. In the city's favor, folks in El Paso smoke few cigarettes.
 

Lenient smoking laws, high asthma mortality, and high asthma prevalence present a challenge to the 79,000 asthma sufferers in Albuquerque. On the positive side, Albuquerque has low levels of ozone air pollution.
 

Home to an estimated 189,000 people with asthma, Indianapolis has high asthma prevalence and a high ratio of written asthma prescriptions. On the other hand, Indianapolis has particularly low pollen levels.
 

The Mobile metro area is home to an estimated 51,000 people with asthma. Although it has a high rate of asthma mortality, Mobile has low levels of non-ozone air pollution.
 

The Tulsa metro area, home to an estimated 76,000 people with asthma, has high pollen levels and asthma prevalence. The good news is that Tulsa's levels of non-ozone air pollution are particularly low.
 

A climate free of extreme heat and cold, with few smokers and low pollen levels helps position Orange County at the top of the asthma comfort list. "California is a great place for asthma sufferers," revealed Sperling. "The mild climate and strict smoking legislation greatly minimize asthma triggers."
 

San Jose scores particularly well thanks to a mild climate, strict smoking legislation, and a low asthma mortality rate.

Monmouth-Ocean has low pollen levels, low non-ozone pollution levels, andlow asthma prevalence.
 

San Diego's climate is one of the best in the country for asthma sufferers, and it scores well with low levels of cigarette smoking and pollen.
 

The McAllen-Edinburg-Mission area ranks highly thanks to low asthma prevalence and low levels of pollen and non-ozone pollution. Syracuse, NY: Syracuse has particularly low asthma prevalence and low levels of pollen and non-ozone pollution.
 

Syracuse has particularly low asthma prevalence and low levels of pollen and non-ozone pollution.
 

Middlesex-Somerset-Hunterdon has low asthma mortality and low levels of pollen and non-ozone pollution.
 

Honolulu scores well with a mild climate and low levels of pollution and pollen.
 

West Palm Beach-Boca Raton has particularly low pollen levels, non-ozone pollution levels, and asthma prevalence.
 

Los Angeles-Long Beach scores well thanks to low pollen levels and a good climate.