Overview:
- Detroit is now the most challenging city in the U.S. for asthma sufferers, according to the Asthma and Allergy Foundation of America's 2025 report.
- Ranking the 100 largest U.S. metro areas, the report considers asthma prevalence, emergency visits, and deaths.
- Detroit reclaimed the top spot after being third in 2024 and fifth in 2023. Released during September's "Asthma Peak Month," the report highlights rising hospitalizations linked to ragweed pollen, respiratory infections, and poor indoor air quality in schools.
Detroit is the most challenging city in the nation to live with asthma, according to the Asthma and Allergy Foundation of America’s 2025 Asthma Capitals report released Tuesday.
The annual report ranks the 100 largest U.S. metro areas based on asthma prevalence, emergency department visits, and asthma-related deaths. Detroit rose to the top spot this year after ranking third in 2024, fifth in 2023 and first in 2022.
“Nearly 28 million people in the United States have asthma,” said Kenneth Mendez, AAFA’s president and CEO. “For people with asthma, this report makes clear that where they live plays a significant role in their quality of life.”
Top 10 asthma capitals (2025):
- Detroit, MI
- Rochester, NY
- Allentown, PA
- Philadelphia, PA
- Cleveland, OH
- Fresno, CA
- Hartford, CT
- Albany, NY
- Providence, RI
- Milwaukee, WI
The AAFA report’s release coincides with September’s “Asthma Peak Month,” when hospitalizations rise sharply due to ragweed pollen, respiratory infections, and poor indoor air quality in schools. Doctors say the timing is a reminder for residents to make asthma management plans and for policymakers to prioritize long-term solutions.
What drives the rankings
According to Hannah Jaffee, research director at AAFA, the report looks at three factors to determine the rankings: asthma prevalence, asthma-related emergency department visits, and asthma-related deaths.
“Detroit earned the top spot in this year’s report due to its higher-than-average asthma prevalence and higher-than-average asthma death rate,” Jaffee said.
“In fact, Detroit had the second-highest asthma prevalence of all cities we looked at for the report. Air pollution, such as pollution from vehicle exhaust and industrial emissions, is a major risk factor that may contribute to higher asthma prevalence and mortality rates in Detroit.”
AAFA also considers risk factors that influence those outcomes, such as poverty, air pollution, access to specialist care, pollen levels, tobacco use, and rates of health insurance coverage.
Dr. Garen Wolff, an allergist and director of Wolff Allergy Asthma in Midtown Detroit, said the new ranking reflects what she is seeing in her practice. Climate change is directly shaping asthma outcomes in Detroit, she said. Longer allergy seasons mean pollen is in the air for weeks more each year, leaving patients vulnerable for longer stretches of time.
“The seasonal allergies have progressively gotten worse probably every year, and that really affects patients,” she said. “On top of that, the wildfires in recent years have been exceptionally bad, bringing smoke that pushes more people into asthma exacerbations.”
Wildfire smoke has worsened allergic conditions as well, such as runny noses and eye inflammation, sometimes pushing patients with mild or intermittent asthma into moderate disease requiring daily inhalers, Wolff said.
Disparities in asthma prevalence, care
Detroit’s asthma burden has long been worse than the rest of Michigan. From 2017 to 2019, 16.2% of adults in Detroit had asthma, compared to 11.1% of adults statewide. Children in Detroit were nearly twice as likely to be hospitalized for asthma as children across Michigan, and Black Detroiters faced more than three times the hospitalization rate of white Detroiters.
Experts say the causes are multifaceted. Aging housing stock — 80% of which is more than 60 years old — contributes to poor indoor air quality, with mold, dust, and pests acting as common asthma triggers.
Outdoor air quality is another factor: Detroit residents live with emissions from freeways, industrial facilities, and heavy truck traffic. Patterns of historic redlining left Black and low-income communities closer to pollution sources, worsening health outcomes.
AAFA emphasized that asthma outcomes cannot be separated from broader inequities.
“We continue to see cities with high levels of poverty disproportionately bear the burden of environmental injustice,” said Melanie Carver, AAFA’s chief mission officer. “Climate change undeniably impacts all of us, but policymakers should note the conditions that foster the worst asthma outcomes: structural racism, high exposure to air pollution, and inadequate health care.”
Poverty and limited access to care add to the city’s asthma crisis. Detroit’s poverty rate is about three times higher than the state average, and residents face long waits for asthma specialists.
Kathleen Slonager, executive director of AAFA’s Michigan Chapter, noted that Detroit has consistently ranked among the worst U.S. cities for asthma for over a decade, driven by high poverty, poor air quality resulting from traffic and industry, and barriers to health care. While mortality rates have declined, she said, challenges remain.
“Some of the contributing factors for this ranking include our high poverty rate and poor air quality from vehicle exhaust and industrial emissions, along with continued health-care barriers,” Slonager said. She added that AAFA’s Health Education Advancement and Leadership (HEAL) Detroit program is beginning to show measurable improvements in asthma control and quality of life for participants.
Despite more than a dozen standalone asthma practices in the suburbs, Detroiters often must rely on hospital-based care within the city.
learn more
Asthma makes more Detroiters sick than anywhere else in Michigan – and it’s getting worse
Public health officials say it’s ‘not clear’ why the disparity is growing Detroiters get asthma at higher rates than the rest of the state, a disparity that has risen sharply in recent years, according to a new report. In February, the Michigan Department of Health and Human Services (MDHHS) released its analysis of health and…
Medicaid cuts jeopardize Michigan asthma care: ‘This is just going to set everything back’
Cuts to Medicaid could be compounded by rollbacks to other environmental programs and air quality rules that help reduce pollution, experts say.
Resources for parents of children with asthma
Do you have a sick child? Here’s how to know if you should send them to school.
Why Detroit’s asthma crisis persists
Wolff said that while she has not personally seen an increase in asthma-related deaths, she has seen worsening cases. Patients who once had only intermittent asthma now require daily inhalers, and some who stopped taking medication during the summer months returned with severe symptoms during September’s “peak week.”
“I’m not surprised,” she said about the rankings. “Seasonal allergies have progressively gotten worse every year because of climate change — longer spring and allergy seasons. Combine that with wildfire smoke, and it’s a perfect storm. These factors are driving more people to the ER with asthma flare-ups.”
She emphasized that asthma is manageable with consistent care: “Asthma can be controlled. It will not destroy your quality of life as long as you stay on medication and have a primary care physician or specialist involved.”
What Detroiters with asthma can do
Wolff offered several steps residents can take to help reduce risks and manage asthma:
- Establish medical care: Start with a primary care physician and, if possible, see a specialist such as a pulmonologist or allergist-immunologist.
- Take medications consistently: Use daily controller inhalers even when you feel well; don’t stop just because symptoms ease.
- Manage allergies: Treat allergies with prescribed medication to prevent worsening of asthma.
- Improve indoor air: Use a HEPA filter air purifier, remove outdoor clothes and shoes before entering bedrooms, and minimize pollen and allergens in the home.
- Check air quality: Stay indoors on high-pollution or high-pollen days, and limit idling cars and drive-thru use, which contribute to air pollution.
“These are practical steps families can take right now,” Wolff said. “But ultimately, unless we address the larger environmental issues, Detroit is going to keep showing up at the top of this list.”