Numerous studies have shown that there’s a clear link between air pollution exposure and environmental asthma. In fact, environmental factors such as particle pollution and ozone have been known to trigger attacks as well as to make symptoms of asthma and allergies worse. Ozone is typically found in smog, while particle pollution can be found in dust, smoke and haze.

Let’s take a look at the top 5 worst cities for asthma:

1. Springfield, MA
Year after year Springfield, MA has been regarded as being the nation’s ‘Asthma Capital’. In fact, asthma prevalence and asthma-related emergency room visits are particularly higher in Springfield than any other city in the country. Experts suggest that high pollen counts are a primary factor as to why. Experts also believe that air quality, poverty and access to specialists play a key factor as to why asthma rates in Springfield are so high. They also proclaimed that it tends to be higher among impoverished children due to living in large building complexes that are within close proximity of industrial businesses.

2. Dayton, OH
When it comes to environmental asthma, Dayton is believed to be the worst city in Ohio as well as the Midwestern section of the United States. In fact, the city is second in his nation when it comes to asthma-related emergency room visits. It ranks third when it comes to the amount of people who use quick-relief and long-term asthma medication. The pollen count in Dayton is higher than any other city in Ohio and is believed to be the number one reason why people experience severe allergies.

3. Greensboro, NC
As far as the state of North Carolina goes, Greensboro is the worst city you can live in if you have severe asthma. The city has a higher poverty rate than any other city in the state. What this translates to is that many people live within close proximity of industrialized areas which pump pollutants into the air. As a result of financial hardships, many families are not able to seek treatment for their situation. During the summer months when the pollen count is high, these contributing factors further agitate asthma sufferers and triggers thousands of emergency room visits per year.

4. Philadelphia, PA
The Asthma and Allergy Foundation of America consistently ranks Philadelphia as being one of the top five worst places to live with asthma. Based on the fact that it is one of America’s largest metro areas, it comes as no surprise as to why. Several factors contribute to Philadelphia’s high asthma rates with the primary being poor air quality. Another primary contributing factor was poor living conditions. Children in particular are especially vulnerable as some parents are unable to afford things like air conditioning units which help to rid the house of environmental agitators such as dust and other particle pollutants.

5. Cleveland, Ohio
The Asthma Capital Report consistently ranks Ohio as being one of the most challenging places to live if you have asthma or breathing problems. Experts believe this is largely due to its high pollen count. It’s also worth noting however, the Cleveland Clinic’s Asthma Center conducted a study to assess asthma prevalence with environmental factors in the city. The study sought to assess asthma prevalence, annual pollen score, emergency room visits and air quality. Cleveland consistently ranked “worse than average” for all four categories.