Cities That Take Your Breath Away


World Asthma Day comes in May when everyone wants to be outdoors enjoying the breathtaking sights, sounds and smells of springtime. But for the 25 million Americans with asthma, breathtaking is what they're trying to avoid.

The national burden of asthma costs Americans over $50 billion per year in healthcare expenses, missed school and work days, and death. With asthma rates continuing to climb – now over 8 percent of the US population – the burden of asthma on our cities is also growing. But it's not just about asthma prevalence and air quality.

For the 11th year in a row, the Asthma and Allergy Foundation of America (AAFA) released its Asthma Capitals report, ranking the 100 most challenging cities to live in with asthma. The annual study is the most comprehensive nationwide longitudinal analysis of metro area asthma data for the largest cities in the US. AAFA looks at 13 critical factors regarding asthma prevalence, environmental conditions and healthcare utilization. No place is completely safe from asthma, and AAFA's report shows that where you live can make a difference on exposure to asthma triggers, quality of life, costs and access to care. 

Richmond is Top 2014 Asthma Capital
Richmond, VA, is in the No. 1 spot for the second year in a row. Memphis, TN, came in at No. 2, followed by No.3 McAllen, TX, No. 4 Oklahoma City, OK, and No.5 Philadelphia, PA. The ranking assesses factors such as asthma prevalence, morbidity and mortality, local smoking laws, air quality, pollen counts, number of asthma specialists, medication use and the number of emergency room (ER) visits for asthma. Richmond's final score based on all factors contributed to its top ranking again this year. To see the ranking methodology and details for all 100 cities visit

New Top 25 Asthma Capitals for 2014 (see all 100 online)
1.Richmond, VA
2.Memphis, TN
3.McAllen, TX
4.Oklahoma City, OK
5.Philadelphia, PA
6.Chattanooga, TN
7.Fresno, CA
8.Tulsa, OK
9.Chicago, IL
10.Detroit, MI
11.New Haven, CT
12.Allentown, PA
13.Atlanta, GA
14.Augusta, GA
15.Pittsburgh, PA
16.Louisville, KY
17.Bakersfield, CA
18.Springfield, MA
19.Milwaukee, WI
20.Jacksonville, FL
21.Dayton, OH
22.New Orleans, LA
23.Cleveland, OH
24.Stockton, CA
25.Toledo, OH

Severe asthma patient Kenny Beyer has lived with asthma his entire life and understands the risks. "I have been hospitalized 24 times in the past seven years, and admitted to the intensive care unit eight times," says Beyer. "I felt like I had to live in a bubble so I wouldn't have an asthma attack."

"There are many things that we can improve now to make life better for people with asthma," says AAFA spokesperson and asthma patient, Talisa White. "Some patients have a hard time avoiding their triggers, others just don't take daily medications like they should or they don't have access to proper asthma care and education," says White. "Our Asthma Capitals report helps to shed light on the asthma burden in each city, but it also provides a roadmap for improvements."

An Avoidable Burden 
On average, there are over 2,300 visits to emergency rooms for asthma in each US city, each year, and nearly one-quarter of these patients get admitted to the hospital.

"Many ER visits are from people with severe asthma, but not all of them," says Dr. Mario Castro, a professor of medicine and pediatrics at Washington University School of Medicine in St. Louis. "Many people with less severe asthma show up to the ER too. But much of this is avoidable with new treatments for severe patients and better prevention and care for those with less severe disease."

Results of a national patient survey by AAFA, to be presented at a medical conference later this month, show that many self-identified moderate asthma patients don't always recognize their own asthma as severe despite several severe symptoms, potentially causing them to miss important warnings and clues about their asthma. Nearly half of those surveyed who did not initially report severe asthma, reported symptoms or measures that are indicators of possibly severe asthma.

From the study, 78 percent of self-identified moderate patients reported one or more ER visits within the past year, 60 percent reported missing school or work due to their asthma, 55 percent reported that their doctor recently increased their asthma medication, and 17 percent reported using their rescue inhalers at least once a day. The survey emphasizes the need for enhanced patient education about recognition and assessment of asthma severity, impairment and risk. The data suggest that patients determine their severity based on the medications they take, not based on their observed symptoms and measures.

Advanced Treatments Give Some Patients New Hope 
Although there have been great strides in asthma research and medications, many patients with severe asthma still can't get their disease under control. In 2010, the U.S. Food and Drug Administration (FDA) approved the first device used in a non-drug procedure for adults with severe persistent asthma which is not well controlled with standard medications.

The procedure, developed by Boston Scientific, is called Bronchial Thermoplasty (BT) delivered by the Alair System. It is an out-patient procedure performed by pulmonologists using controlled energy to reduce excessive smooth muscle in the lungs, decreasing the ability of the airways to constrict and reducing the frequency of asthma attacks.

"After having the BT procedure, now I can take pleasure in the simple things, like walking outside with my wife, going to the shopping mall and enjoying every season of the year," say Beyer. "I no longer live in fear of the next asthma attack because now my lungs are less reactive and I can handle it better with regular medications."

The level of asthma severity and control for each patient is ultimately determined by their doctor. BT is for patients with severe asthma that is not well controlled with medications.

"For certain severe asthma patients, bronchial thermoplasty is a game-changer," says Dr. Castro. "Some patients, who have been afraid of being outdoors for much of their adult lives due to asthma triggers in the air, are finding the joys of spring all over again."


SOURCE Asthma and Allergy Foundation of America