Top 10 Cities With the Highest Asthma Medicine Use (2024)

Asthma, a chronic respiratory condition impacting millions globally, remains a major public health issue. Effective management typically involves a combination of quick-relief and long-term control medications, yet the frequency of their use varies significantly across U.S. cities.

This variation is shaped by a range of factors, such as socioeconomic disparities, access to healthcare, and environmental triggers.

In this article, we explore the cities with the highest rates of asthma medication use, examining the unique challenges each faces and the underlying causes driving these elevated levels of medication reliance.

What is a Controller Medicine for Asthma?

Controller medications, also known as maintenance or preventive medicines, are taken daily to help prevent asthma symptoms and attacks. These medications work by reducing inflammation in the airways over time, making them less sensitive and less reactive to asthma triggers.

They are called “controllers” because they manage the underlying disease, helping to prevent asthma from worsening.

Types of Controller Medications

• Inhaled corticosteroids (e.g., Flovent, Pulmicort, Qvar): These reduce airway inflammation.
• Long-acting beta-agonists (LABAs) (e.g., Serevent, Foradil): Help keep airways open over time.
• Combination inhalers (e.g., Advair, Symbicort, Dulera): Combine corticosteroids with LABAs for long-term control.
• Leukotriene modifiers (e.g., Singulair): Reduce airway inflammation by blocking leukotrienes, which contribute to asthma symptoms.

Note: Controller medications are not designed to provide immediate relief of symptoms. They need to be taken consistently to be effective in managing long-term inflammation.

What is a Reliever Medicine for Asthma?

Reliever medications, also known as rescue or quick-relief medicines, provide fast relief from asthma symptoms when they occur. These medications work by relaxing the muscles around the airways, allowing them to open up quickly and improve airflow.

They are most effective for relieving symptoms like wheezing, coughing, chest tightness, and shortness of breath within minutes.

Types of Reliever Medications

• Short-acting beta-agonists (SABAs) (e.g., albuterol, levalbuterol, pirbuterol): These are the most commonly used quick-relief medications.
• Anticholinergics (e.g., ipratropium): Help open airways by blocking certain nerve signals.

Note: Reliever medications do not address the underlying inflammation that causes asthma. If you’re using your reliever medication more than twice a week, it may indicate poor asthma control, and you should consult your healthcare provider for a better management plan.

Cities with the Highest Asthma Controller Medicine Use

Each year, the Asthma and Allergy Foundation of America (AAFA) publishes a detailed report on the “Asthma Capitals,” highlighting cities with the highest rates of asthma controller medicine use.

These cities face unique environmental and socioeconomic challenges that contribute to higher asthma prevalence and the need for consistent medication to manage the condition.

Here are some of the cities with the highest asthma controller medicine use:

• Pittsburgh, PA: Known for its industrial history, Pittsburgh has long struggled with air quality issues. Despite improvements, the city’s past as a steel production hub continues to affect asthma rates. The high use of controller medications here reflects efforts to manage the large population of asthma patients and ongoing environmental triggers.
• Rochester, NY: With elevated pollen levels, particularly in the spring and summer, Rochester residents frequently battle asthma flare-ups. As a result, the city sees significant reliance on asthma controller medicines to help patients manage environmental triggers and prevent attacks.
• Harrisburg, PA: Pennsylvania’s capital has high asthma controller medicine use, likely due to a combination of factors, including air quality concerns and the availability of healthcare. Harrisburg’s urban and industrial areas contribute to elevated asthma rates, making daily control essential.
• Virginia Beach, VA: As a coastal city, Virginia Beach experiences high humidity and salt-laden air, both of which can exacerbate asthma symptoms. The city’s high use of controller medications helps residents manage these environmental challenges.
• Grand Rapids, MI: Grand Rapids has a history rooted in manufacturing, which has contributed to air quality issues over time. This industrial legacy, combined with seasonal allergens, results in elevated asthma rates and high usage of controller medications.
• McAllen, TX: Situated in the Rio Grande Valley near the U.S.-Mexico border, McAllen’s air quality is affected by cross-border pollution. This factor, along with high pollen levels, contributes to the city’s significant reliance on asthma controller medicines.
• El Paso, TX: Another border city, El Paso experiences frequent dust storms and a dry climate, both of which can trigger asthma symptoms. High use of controller medications is necessary for many residents to manage these environmental factors.
• Jackson, MS: The capital of Mississippi, Jackson faces high poverty rates and limited access to healthcare, both of which contribute to asthma prevalence. Poor air quality and a lack of resources for asthma management further drive up the need for controller medications in this city.
• Boise, ID: Known for its outdoor activities, Boise is also notorious for high pollen counts during the spring and summer months, which trigger asthma attacks. Controller medication use is widespread as residents manage asthma symptoms tied to seasonal allergens.
• Toledo, OH: Toledo, with its industrial background and location near Lake Erie, grapples with air quality issues. The city’s industrial pollution has long contributed to elevated asthma rates, and the high usage of controller medicines reflects this ongoing challenge.

Note: Each of these cities faces distinct environmental and social challenges that drive higher asthma rates and the need for effective management through controller medications.

Cities with the Highest Asthma Quick-Relief Medicine Use

The AAFA’s annual report also highlights cities where quick-relief, or emergency, asthma medications are most frequently used.

These medications provide fast relief from asthma symptoms during attacks, and their high usage in certain cities reflects the prevalence of asthma triggers and underlying challenges in managing the condition.

Here are some of the cities with the highest reliance on quick-relief asthma medication:

• Rochester, NY: Known for a high prevalence of asthma, Rochester’s challenges are compounded by significant poverty and a lack of health insurance for many residents. Poor air quality and high pollen levels further exacerbate asthma symptoms, driving up the need for quick-relief medication.
• Pittsburgh, PA: With its industrial past, Pittsburgh struggles with air pollution that continues to trigger asthma attacks. This has led to high usage of quick-relief medications as residents manage frequent flare-ups.
• McAllen, TX: In southern Texas, McAllen faces high rates of asthma, which are influenced by socioeconomic factors like poverty and limited healthcare access. Cross-border pollution and high pollen levels also contribute to the city’s elevated need for emergency asthma medications.
• Toledo, OH: Industrial activities in Toledo contribute to poor air quality, making asthma a persistent issue for residents. The city’s reliance on quick-relief medication reflects the frequent asthma attacks triggered by these environmental factors.
• Dayton, OH: Like Toledo, Dayton deals with socioeconomic challenges and industrial pollution, both of which increase asthma attacks and the need for fast-acting asthma treatments.
• Akron, OH: Akron faces similar issues to other Ohio cities, with high poverty rates and limited healthcare coverage contributing to frequent asthma attacks. As a result, quick-relief medication usage remains high.
• Lakeland, FL: In Florida, Lakeland’s subtropical climate brings high humidity and allergens, both of which can worsen asthma symptoms. Coupled with socioeconomic factors, this leads to significant reliance on quick-relief asthma medications.
• Cleveland, OH: Cleveland struggles with high poverty and uninsured rates, which, along with air pollution, contribute to frequent asthma exacerbations. This has led to increased usage of quick-relief medications across the city.
• Columbus, OH: The capital of Ohio faces similar challenges as other cities in the state, with high poverty levels, inadequate healthcare access, and poor air quality driving up the need for emergency asthma treatments.
• Harrisburg, PA: Harrisburg’s industrial history, combined with its socioeconomic challenges, leads to frequent asthma attacks among residents. This has resulted in a high reliance on quick-relief asthma medications.

These cities face a combination of environmental and socioeconomic factors, including poor air quality, high poverty rates, and limited access to healthcare, which contribute to the frequent use of quick-relief asthma medications.

Managing asthma in these areas requires addressing both immediate symptoms and the underlying conditions that make the disease harder to control.

Factors That Contribute to More Frequent Asthma Medicine Use

Several key factors can influence the need for more frequent asthma medication use, particularly quick-relief or rescue medications. These factors reflect both environmental and socioeconomic challenges that make asthma harder to control.

Here are some of the most significant contributors:

• Poverty: Economic hardship directly affects access to proper asthma care, including the costs of medication, emergency department visits, and hospitalizations. Even with health insurance, many people cannot afford the necessary treatments to manage their condition effectively. Individuals living below the poverty line spend an estimated $3,581 annually on asthma management, often relying on quick-relief medications due to barriers in accessing long-term solutions.
• Lack of Health Insurance: For the uninsured, the cost of asthma care becomes an even greater burden. Without coverage, individuals must pay out-of-pocket for their treatments, making quick-relief medications a more affordable, albeit short-term, option. This lack of affordable care can result in poor asthma control and increased use of emergency medications.
• Air Pollution: Both outdoor and indoor air pollution significantly contribute to asthma flare-ups. Exposure to vehicle emissions, industrial pollutants, tobacco smoke, mold, and other environmental toxins can trigger asthma symptoms. These triggers lead to more frequent reliance on quick-relief medications as people manage acute attacks caused by poor air quality.
• Limited Access to Specialists: Inadequate access to asthma specialists can prevent individuals from receiving comprehensive care, including proper diagnosis and long-term management plans. Without regular access to specialists, many patients are left relying on quick-relief medicines, rather than the controller medications that help prevent symptoms from worsening over time.
• Other Risk Factors: Environmental triggers such as high pollen counts and smoking (including cigarettes, cigars, and vapes) can worsen asthma symptoms. These factors often lead to an increase in quick-relief medication use as individuals struggle to manage frequent symptoms.

These factors underscore the importance of comprehensive asthma management that addresses both medical needs and social determinants of health.

Improving access to healthcare, reducing environmental triggers, and providing affordable treatments are essential for reducing the reliance on quick-relief medications and improving overall asthma control.

Final Thoughts

The high usage of asthma medications in these cities highlights the urgent need for comprehensive and accessible asthma care. Addressing asthma effectively requires a holistic approach that not only focuses on medical treatments but also addresses the social determinants of health that exacerbate the condition.

By understanding the unique challenges each city faces—whether related to air quality, healthcare access, or socioeconomic factors—we can develop targeted interventions to reduce the burden of asthma and improve health outcomes.

These findings also emphasize the importance of continued research and policy efforts to eliminate disparities in asthma care, ensuring that all individuals living with asthma have the resources and support they need for a better quality of life.