For the past six years, the Asthma and Allergy Foundation of America (AAFA) has evaluated conditions in the 100 largest cities in America and ranked them based on the quality of life each affords for people with asthma. Researchers at AAFA review 12 factors that impact the quality of life for people with asthma, including: the crude death rate for asthma; the estimated prevalence of adult and pediatric asthma; risk factors, such as air pollution, pollen counts and public smoking; and medical factors, such as the number of asthma medications used per patient and the number of asthma specialists in the area. Below is a list of the cities that rank worst in quality of life for people with asthma in 2009.

This year’s top 10 worst cities in the U.S. to live in if you have asthma are:

1. St. Louis, MO. This Midwest city tops the list this year after coming in ninth last year, due to a variety of factors, including poor air quality and a rise in the percentage of uninsured residents.
   
   
2. Milwaukee, WI. Climbing up one spot from last year, Milwaukee has rates of self-reported asthma and estimated asthma prevalence that are higher than average, poor air quality, and only below average use of asthma control medications.
   
   
3. Birmingham, AL. Jumping all the way up from number 13 on the list last year, Birmingham saw an increase in estimated asthma prevalence and ranks poorly in air quality and public smoke free laws. In fact, all of the cities that make the top 10 lack public smoking bans.
   
   
4. Chattanooga, TN. Rising twelve spots from last year, this Appalachian city saw an increase in the crude asthma death rate and a decline in the use of rescue medications from last year. Chattanooga also ranks below average in air quality.
   
   
5. Charlotte, NC. While this Southern city has an above average rate of estimated asthma prevalence, Charlotte saw a jump in its annual pollen score, which accounts for its rise from last years position in the number seven spot.
   
   
6. Memphis, TN. A small bright spot on the list, Memphis improved in self-reported asthma incidence, annual pollen score, and uninsured rate from last year, causing it to drop one spot from last year’s list. High crude death rates from asthma and poor air quality still negatively impact people living with asthma in Memphis.
   
   
7. Knoxville, TN. Home to the University of Tennessee, Knoxville improved its ranking considerably over last year when it held the top spot. Knoxville improved because both the estimated and self-reported prevalence of asthma decreased, and reported pollen levels were lower than the national average. However, poor air quality and low adherence to asthma medications keep Knoxville in the top 10.
   
   
8. McAllen, TX. Perhaps not a household name, this border town near Brownsville jumps all the way up from number 26 last year. While the air quality ranking actually improved from last year, increases in the estimated and self-reported asthma prevalence and the annual pollen score are responsible for the precipitous rise.
   
   
9. Atlanta, GA. The "Jewel of the South" improved its ranking from last year, moving down from the number four spot thanks to improvements in crude asthma death rate, poverty rate, rate of uninsured people, and use of quick-relief asthma medications. Below average air quality and low numbers of asthma specialists are still a problem in Atlanta.
   
   
10. Little Rock, AK. Rounding out the top 10, Little Rock rose 12 spots from last year to just make the list. Increases in the annual pollen score, air pollution levels, and self-reported asthma rates offset a nice improvement in crude asthma death rate.

No matter where you live, having asthma that is uncontrolled can significantly impact your life and lead to missed school or work, emergency room visits, hospitalization, and even death. If your asthma is poorly controlled, talk to your doctor about making changes to your asthma action plan include adjustments in your current asthma prevention medications. Not sure if your asthma is well controlled? Take the Asthma Quiz Challenge and find out how much you know about uncontrolled asthma symptoms. Learn more by reading the Healia Health Guide to Uncontrolled Asthma.

_{Source: Allergy and Asthma Foundation of America, Asthma Capitals 2009, Jan 2009. http://www.aafa.org/pdfs/2009ACPublicList.PDF}