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TUESDAY, March 16 (HealthDayNews) -- Springtime and the breathing isn't easy -- particularly if you have asthma and live in Knoxville, Tenn.; Little Rock, Ark.; St. Louis; Madison, Wisc.; or Louisville.

That's the conclusion of a new survey from the Asthma and Allergy Foundation of America that ranks the 100 largest U.S. cities by asthma risk. The just-mentioned cities occupy the top five slots. Daytona Beach, Fla.; Miami; and San Francisco conclude the list.

"The importance of the Asthma Capitals list is to help people realize that asthma is one of the most significant health problems among children and adults in the U.S.," says Mike Tringale, a spokesman for the Asthma and Allergy Foundation of America.

But asthma is a problem all over the country, he says, adding, "There is no place safe from asthma."

The researchers who compiled the list took into account many factors. They included the prevalence of asthma, deaths from asthma, outdoor air quality and pollen counts, smoking laws, the number of prescriptions for asthma medications, and the number of asthma specialists in each city.

In addition, the researchers considered poverty levels, which are associated with an increased risk for asthma and less access to health care.

They also looked at laws that prevent children from bringing their asthma medication to school, Tringale says.Such laws must be abolished and children allowed access to their inhalers, says Dr. Thomas Robins, a professor of environmental and occupational medicine at the University of Michigan. Children have died in school from asthma attacks because they weren't allowed to have inhalers, he adds.

By examining all these risk factors, the researchers were able to construct a list based on quality-of-life factors as well as the number of reported asthma cases.

"That's why the largest cities, like New York and Chicago, are not at the top of the list, which may surprise some people," Tringale says.

"In determining the city rankings, we looked at all the factors that affect an individual with asthma, that make it more or less difficult to live in that city," he says.

So while Knoxville is at the top of the list, it doesn't mean asthma is not a problem in other cities, Tringale says.

The list is timely because allergy season has arrived early in many parts of the country, Tringale says. "And believe it or not, even people who have asthma have never heard about the most common form of asthma -- allergic asthma."

Of the 20 million Americans who have asthma, 10 million have allergic asthma, Tringale notes. Allergic asthma is a chronic inflammatory disorder of the airways, and its symptoms are made worse by exposure to allergens such as dust, mold and pollen. While allergic asthma is a problem all year long, it can strike hard in spring with the presence of more pollen in the air, he says.

This year, pollen counts are rising earlier than usual in many parts of the country because of a mild winter and more rain, Tringale says.

Dr. Stanley Goldstein, a member of the board of directors of the American Academy of Allergy, Asthma and Immunology, agrees that the most common cause of asthma is allergies.

That's why the academy and the Asthma and Allergy Foundation of America have started a campaign called "Is Your Asthma Allergic? Know Your IgE."

If you have allergic asthma, immunoglobulin E (IgE) antibodies are produced after exposure to allergens, such as dust, pet dander, pollen or mold spores. The antibodies can cause the release of chemicals that trigger the inflammation of the airways, and the coughing and wheezing of an asthma attack, Goldstein says.

Goldstein says the academy has developed an asthma screener that's available on its Web site (www.aaaai.org/allergicasthma). "Using this screener can give you an idea if you have asthma. And then you can go to an asthma specialist and get your asthma under control," he says.

Robins says asthma can be a life-threatening illness and many people with asthma don't have their asthma under control. So, there needs to be more awareness of asthma both among patients and physicians, he says.

"With proper education and medication, the vast majority of asthmatics can keep their asthma under control and lead a normal life," Robins says.

More information

The American Academy of Allergy, Asthma and Immunology has information on self-screening for asthma. The Asthma and Allergy Foundation of America has more on asthma treatments and you can also peruse through the Asthma Capitals list.

(SOURCES: Mike Tringale, spokesman, Asthma and Allergy Foundation of America, Washington, D.C.; Stanley Goldstein, M.D., American Academy of Allergy, Asthma and Immunology Board of Directors, director, Allergy and Asthma Care of Long Island, and director of Island Medical Research, Rockville Centre, N.Y.; Thomas Robins, M.D., M.P.H., professor, environmental and occupational medicine, University of Michigan, Ann Arbor)

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