Knoxville Retakes Top Spot as Nation’s Asthma Capital
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Knoxville Retakes Top Spot as Nation’s Asthma Capital
What do Knoxville, Atlanta, Charlotte and Memphis have in common? More than a profusion of blooming flowers, fast-growing weeds and ferocious winds around which grass and tree pollen swirl. These four southern markets in which Medical News, Inc. publishes monthly journals rank among the top 10 asthma capitals of the United States.

For the third time in five years, the Asthma and Allergy Foundation of America (AAFA) ranked Knoxville, Tenn. as the most challenging place to live with asthma. Knoxville’s rise to the top of the 2008 rankings is partly due to East Tennessee’s higher than average annual pollen counts, high pollution, weak public smoking bans, and the high use of asthma “rescue” medications per patient.

“Everyone in the medical community in Knoxville sees first-hand how this area affects asthma patients,” said Dr. Bob Overholt, a board-certified allergist in Knoxville, and a national expert on asthma. “It’s not just a spring or fall problem anymore. We see asthma patients all year long, and for many reasons.”

After being ranked first in 2004 and 2005, Knoxville had dropped down but never entirely moved off the list.

“Knoxville keeps appearing as a severe place for people with asthma but people should not move away from cities just because they’re on the list,” noted AAFA spokesperson Mike Tringale, “You can’t move away from asthma. We hope this ranking encourages patients to work better with their doctors to develop a better daily asthma management plan no matter where they live.”

Of the top 10 cities considered the most challenging places to live with asthma, six are located in the Deep South: two each in Tennessee (Memphis and Knoxville) and North Carolina (Charlotte and Greensboro); one each in Georgia (Atlanta) and South Carolina (Greenville). 

To determine the rankings, AAFA has conducted scientific research since 2004 to evaluate conditions in the largest 100 metropolitan areas in America and to rank them based on the quality of life for people with asthma in each city. The foundation reviews 12 factors grouped into three categories: prevalence, such as the crude death rate for asthma and the estimated prevalence of adult and pediatric asthma; risk factors such as air pollution, pollen counts and public smoking bans; and medical factors, such as the number of asthma medications used per patient and the number of asthma specialists practicing in the area. A full report of the rankings was sponsored by a grant from AstraZeneca, a pharmaceutical company that has developed and marketed asthma treatments for the last two decades.

Beyond the top 10 ranking, a dozen southern cities round out the top 100, including the Alabama cities of Birmingham (13) and Mobile (28), Louisiana metropolitan areas of Baton Rouge (70) and New Orleans (82), and Florida hotspots Tampa Bay (64) and Orlando (80).

Including the top 10 spots, Tennessee has more asthma-challenged cities (five) than its neighbors, with Chattanooga (16), Johnson City (17) and Nashville (29). State capitals Raleigh, N.C. and Jackson, Miss. ranked No. 42 and 84, respectively. Another, Little Rock, Ark., moved from No. 17 (2006) to 10 (2007), and then to 22 (2008).

Tringale explained that rankings sometimes shift simply because of the movement of one city on the list – Washington, D.C. jumped from No. 52 to 4 one year – or for more complex reasons such as determining factors not being weighted equally.

Lois Turley, allergy nursing director for the Arkansas Center for Ear, Nose, Throat and Allergy in Fort Smith, keeps a climate blog updated on her Web site,, to track people’s experience with allergens in various parts of the country.
“No place is allergen-free,” noted Turley. “No place.”

Top 2008 Asthma Capitals

1.   Knoxville, Tennessee

2.   Tulsa, Oklahoma

3.   Milwaukee, Wisconsin

4.   Atlanta, Georgia

5.   Memphis, Tennessee

6.   Allentown, Pennsylvania

7.   Charlotte, North Carolina

8.   Greenville, South Carolina

9.   St. Louis, Missouri

10. Greensboro, North Carolina

Find the full rankings and complete data for all 100 cities at

Fast Facts about Asthma

Asthma, a condition characterized by an inflammation to airways in the lungs, resulting in chronic wheezing, coughing and difficulty breathing, has a significant impact on both individuals and society, and is responsible for:
  • More than 4,000 deaths annually;
  • More than 500,000 hospitalizations every year;
  • 14.6 million missed days of school annually, making asthma the leading cause of school absenteeism;
  • 14.5 million missed days of work for adults each year;
  • 1.9 million emergency room visits annually; and
  • $18 billion in medical expenses and indirect costs each year.           

AAFA Takes Proactive Measure

To help promote asthma and allergy friendly consumer products, AAFA is partnering with the international research organization Allergy Standards Limited (ASL), a physician-led group, to offer the “asthma & allergy friendly™” certification program, the first of its kind in the nation to write, publish and apply product standards for a wide variety of asthma and allergy friendly consumer products.
The special certification mark will assist consumers in choosing appropriate products including plush toys, pillows, bedding, bedding barriers, vacuums, paints, flooring and more.

For more information, visit

April 2008


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