3 Pennsylvania cities ranked among worst places to live for people with asthma

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Three Pennsylvania cities were recently ranked among the worst in the country for people living with asthma.

Allentown, Philadelphia and Harrisburg were included in the Asthma and Allergy Foundation of America’s 2025 U.S. Asthma Capitals report, published earlier this month.

The report, which identifies places with high rates of asthma prevalence, asthma emergency department visits and asthma-related deaths, put Allentown at No. 3, Philadelphia at No. 4 and Harrisburg at No. 15.

This year’s annual rankings show that Pennsylvania cities continue to struggle when it comes to protecting people from environmental triggers like air pollution and mold exposure and ensuring access to maintenance medications and inhalers, experts say.

“There’s a number of things that are not going well in the asthma ecosystem,” said Ana Santos Rutschman, health law professor at Villanova University. “It is one of the major public health problems we face nationally and then in a more pronounced way in certain regions including in the Philadelphia, Pennsylvania areas.”

A lack of access to affordable medication

Towns and cities named as “asthma capitals” are more likely to have higher rates of poorer indoor and outdoor air quality, poverty and more people who are uninsured or underinsured — all risk factors that can make it difficult for people to manage asthma.

Long-term medications can help keep asthma under control and reduce the likelihood of asthma attacks, but they’re often prescribed by a specialist, which not everyone has access to depending on where they live or their health insurance status, Rutschman said.

Additionally, inhalers can be used to deliver urgent “rescue medications” to prevent or treat asthma attacks, which can lead to hospitalization or death in the most severe cases. But they can be expensive.

“Even that ends up with a price tag that many parents just cannot afford,” said Rutschman, who is also the director of the Villanova Law Health Innovation Lab.

The cash price for some brand-name inhaler medications can be several hundred dollars without insurance coverage. Generics can be cheaper, but can also be priced at over $200.

“It has been a puzzling one for me because it’s older technology, the patents have expired on the drugs that many of these inhalers dispense, so it’s nothing that should cost a lot of money,” Rutschman said.

Even with medication, people can still suffer if they’re regularly exposed to polluted outside air, smoke from cigarettes or vapes and indoor mold, which is more often found in aging infrastructures. For kids, that could include older school buildings.

Some seasonal allergens in certain parts of the country can also exacerbate symptoms for the people who live there. In the tri-state area, September is one of the worst months of the year for asthma attacks and emergency room visits.

Medication price caps and limiting environmental triggers

Increasing access to asthma medications and inhalers by making treatments more affordable would be a major step in addressing the magnitude of this public health problem, Rutschman said.

“If we can actually manage this instead of letting it get progressively worse, fewer people will have to go to the ER, fewer people will need encounters with the health care system, the hospital system, down the road,” she said.

Several pharmaceutical manufacturers of major inhaler asthma medications announced last year that they would cap out-of-pocket costs at $35 for a month’s supply of drugs, but only for fully-insured people with private health plans, not for people using public programs like Medicare or Medicaid.

While price caps can be an effective way to increase access to treatment, especially for people with low incomes, Rutschman said doing it this way is flawed, because without federal or state laws mandating the caps, companies can change their policy at any time.

In the meantime, she said adults and children with asthma can use websites like GoodRx, which helps people search for medication prices and discounts at their local pharmacies.

Avoiding or limiting exposure to environmental triggers like smoke and hazardous outdoor air conditions can be beneficial. States and cities could also create incentive programs to encourage more mold remediation from older buildings and structures, Rutschman said.