After more than a decade, Philadelphia remains one of the most challenging places in the United States to live with asthma.

That’s according to the 2026 Asthma Capitals report released Sept. 1 by the Asthma and Allergy Foundation of America (AAFA). Every year, AAFA ranks the 100 most populous cities in the contiguous United States based on asthma prevalence, asthma emergency visits and asthma-related deaths.

Philadelphia was ranked No. 4, while Pennsylvania cities Allentown, Harrisburg and Pittsburgh were listed at No. 1, 32 and 68, respectively. Philadelphia has the sixth-highest prevalence rate and the seventh-highest mortality rate, according to AAFA. The city has consistently been named one of the top 10 “asthma capitals” since 2013.

Dr. Samantha Pettigrew, an assistant professor of clinical thoracic medicine at Temple University, said that could be due to healthcare costs, tobacco exposure and poor air quality. Philadelphia has higher adult cigarette smoking and poverty rates than most U.S. cities. Some residents may lack access to adequate care for their asthma, such as medications and specialists, Pettrigrew said. Generic inhalers can cost less than $100, according to GoodRx, but some combination and maintenance brands cost several hundred a month without insurance.

In Northwest Philadelphia, the areas around Wissahickon Valley Park have low asthma rates, while places further east — like Germantown, Nicetown and Logan — surpass the 95th percentile. Asthma is most prevalent in the northern and western parts of the city, according to the state’s Department of Environmental Protection PennEnviroScreen tool.

These areas tend to have fewer trees and more air pollution compared to other parts of the city.

“If you live in a place where you’re exposed to a lot of fumes — like car exhaust or railway exhaust — that can predispose you to developing asthma and make your symptoms worse if you already have it,” said Pettigrew, who sees patients at Temple Lung Center’s Chestnut Hill and North Philadelphia locations. “I have some patients who work full time at an airport outside, and often they experience asthma from that.”

AAFA released its report at the start of asthma peak season, the period with a significant spike in medical visits. The season typically starts in September and October, when kids return to school and the respiratory infection season begins. Respiratory illnesses are a key driver of asthma-related emergency department visits and hospitalizations, the report says.

The organization released the report to raise awareness about the challenges people with asthma face each year, especially in the fall, and remind people to be mindful about managing their symptoms during the next few months.

Roxborough Memorial Hospital and Temple University Hospital usually see the biggest increase in asthma-related visits during the winter months around respiratory season. Pettigrew recommends that people with asthma carry an inhaler at all times, work with their doctors to develop an asthma management plan and — to be extra cautious — buy an air purifier to improve the air quality in their homes.

AAFA experts also recommend getting vaccinated for the flu, COVID-19, RSV and other respiratory illnesses.

“(We) really hope that people feel empowered … even those small steps that you take as an individual can make a big difference,” said Hannah Jaffee, research director at AAFA.

The report serves as a call to action to support the nearly 28 million people in the United States with asthma, according to AAFA. Kenneth Mendez, president and CEO of AAFA, said in a news release that policymakers should be expanding peoples’ access to adequate asthma care, but recent federal policies are doing the opposite. In the past year, Congress and President Trump have made significant health policy shifts, including enacting new Medicaid requirements.

“Our Asthma Capitals report should be a wake-up call for policymakers and a roadmap for policy improvements,” Mendez said in the release.

The social and environmental state of a city can significantly impact asthma rates. Top-ranked cities tend to share high levels of air pollution, high poverty rates, a lack of access to asthma specialists and high pollen counts, all of which are risk factors, Jaffee said.

This year’s report marks the third time in the past four years that Allentown has been placed at the top. It’s situated in a valley between major highways, which could trap air pollution, Jaffee told 69 News WFMZ-TV. Other potential factors could include the city’s older housing stock and lack of smoke-free laws, she said.

Abby Weiss is an environmental reporter for the Local and a Report for America corps member. She can be reached at abby@chestnuthilllocal.com.