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2002: America's Asthma 'Hot Spots' Identified

Research Triange Park, NC, October 29, 2002 - A new analysis of the nation's 100 largest metro areas has identified 25 asthma "hot spots" where high prevalence makes the condition a key issue and environmental "triggers" and other factors can make living with asthma a particular challenge.

The rankings - conducted by statistician Bert Sperling, well known for his annual "Best Places" lists - examined local asthma prevalence and mortality data, as well as other factors such as pollen scores, air pollution, asthma prescriptions, smoking laws and the number of asthma specialists. By combining measures of the scope and impact of asthma, as well as data for asthma "triggers" such as air pollution or tobacco smoke, Sperling was able to rank the cities and identify 25 hot spots.

Tucson, Arizona topped the list as the number one asthma hot spot among the metro areas ranked, with Kansas City, Missouri; Phoenix, Arizona; Fresno, California and New York City, New York rounding out the top five.

"Effective asthma management is vital for asthma patients across the country, no matter where they live," said Dr. Anthony Rooklin, Co-Director, Division of Allergy, Crozer Chester Medical Center in Philadelphia. "But people living in these hot spots should pay attention to local conditions or factors that could aggravate their asthma, and make sure that their asthma is properly controlled to minimize the risk of asthma symptoms and attacks."

The rankings were sponsored by GlaxoSmithKline, maker of Advair Diskus“ (fluticasone propionate and salmeterol inhalation powder) to raise awareness about asthma and asthma triggers, and to encourage people to learn more about how to properly manage asthma. Sperling's analysis identified the following metro areas as the nation's 25 asthma hot spots:
1) Tucson, AZ 13) Wichita, KS
2) Kansas City, MO 14) Louisville, KY
3) Phoenix-Mesa, AZ 15) Chicago, IL
4) Fresno, CA 16) Denver, CO
5) New York, NY 17) Dallas, TX
6) El Paso, TX 18) Youngstown-Warren, OH
7) Albuquerque, NM 19) Portland, OR
8) Indianapolis, IN 20) Cleveland-Lorain-Elyria, OH
9) Mobile, AL 21) Springfield, MA
10) Tulsa, OK 22) Tampa-St. Petersburg-Clearwater, FL
11) Cincinnati, OH 23) Birmingham, AL
12) Fort Worth-Arlington, TX 24) Omaha, NE
25) Sacramento, CA

"Often, people consider only asthma prevalence or mortality rates to determine where asthma has the greatest impact. But when you look at other data, including environmental factors that can be asthma triggers, a different picture emerges," said Sperling.

According to national asthma management guidelines,1 a key goal of asthma therapy is to prevent symptoms that can restrict activities or otherwise interfere with a person's lifestyle. Unfortunately, however, poorly controlled asthma does negatively impact the lifestyles of many Americans. A landmark asthma survey found that nearly half (48 percent) of all people interviewed said that asthma limited them in sports and recreation, a third (31 percent) said it limited their lifestyle, and one in four (25 percent) said it limited their social activities. 2 A 2001 survey of women with asthma found that 40 percent have had to decline, cancel or interrupt a social event because of their asthma. 3

"Ideally, asthma symptoms should not interfere with people's lifestyles or prevent them from taking advantage of what their city has to offer. Asthma should not disrupt daily routines or get in the way of normal activities," said Dr. Rooklin. "The good news is that today we understand how to manage asthma more effectively and conveniently than ever."

Whether or not a person lives in an asthma hot spot, national treatment guidelines recommend that people with the condition follow these tips for keeping their asthma well controlled:

  • Avoid asthma triggers. People with asthma should try to stay away from triggers like tobacco smoke whenever possible. While it is more difficult to avoid some triggers, such as climate and air pollution, properly managed asthma can help reduce symptoms and risk of attacks.
  • Take a preventative approach to managing asthma. People with asthma should work with their doctor to develop a written asthma action plan, which may include daily maintenance medications that can help prevent symptoms and reduce the risk of attacks. Treatment guidelines developed by the National Institutes of Health1 state that an inhaled corticosteroid with a long-acting inhaled bronchodilator is the preferred treatment option for people who have asthma symptoms every day.
  • Keep track of symptoms with a simple diary, which can help a physician determine how well a treatment plan is working. A peak flow meter can help people measure their lung function at home.
  • See a healthcare professional regularly, at least once every six months.

About Asthma
Asthma is a chronic lung disease. Both inflammation (swelling and irritation) and constriction (tightening of the muscles around the airways) cause the airways to narrow, leading to symptoms that include cough, wheezing, shortness of breath and chest tightness. Though there is no cure, advances in research and preventative treatments in the past decade have made asthma a more controllable condition.

Yet, for many Americans, asthma remains out of control. On an annual basis, asthma accounts for approximately 5,000 deaths, 4 500,000 hospitalizations, 5 two million emergency department visits, 4 14 million missed school days6 and 14.5 million missed work days. 6 In 2000, asthma cost the U.S. economy an estimated $14 billion. 7

About the Rankings
Rankings were calculated using the latest available metro-area data from numerous U.S. government and industry sources. In consultation with GlaxoSmithKline medical and epidemiological experts, each data set was assigned a weight to reflect its relative importance as an indicator of either the impact of asthma on a particular area or the challenges a person living in this area would encounter in his or her daily life.

The criteria used in developing the rankings, listed in the order that they were weighted, were: asthma prevalence, asthma mortality, pollen scores, number of asthma specialists (per 100,000 population base), ratio of prescriptions for rescue medications to prescriptions for controller medications (an indicator of proper asthma treatment), air pollution (both ozone and non-ozone), smoking laws, climate and prevalence of tobacco use. Data about asthma morbidity, such as hospitalization rates or emergency department visits, is not available at the metro or county level and therefore was not able to be included.

Sperling used computer models to perform the calculations based on the experts' ranking and the statistical data for each city. The cities were then ranked, providing a list of asthma hot spots.

The type of analysis used is similar to a "conjoint analysis." To compare each category with the others, each data element for each metro area is assigned a point value on a common scale. The exact formula for calculating point values is complex, using standard deviations and rules developed over the 18 years Sperling has been working in this field. With each category assigned point values on a common scale, the relative status of each place in each category can be compared, weighted, summed and ranked.


  1. National Heart, Lung, and Blood Institute, National Institutes of Health. Practical Guide for the Diagnosis and Management of Asthma. NIH Publication No. 97-4053. October 1997.
  2. Asthma in America, October 1998; Schulman, Ronca and Bucuvalas, Inc. and Glaxo Wellcome Inc. For more information about the survey and its methodology, visit
  3. Women and Asthma in America: Understanding the Impact, December 2001. A telephone survey of 501 adult women with asthma; Schulman, Ronca and Bucuvalas, Inc. and GlaxoSmithKline.
  4. American Lung Association. Epidemiology and Statistics Unit, Best Practices and Program Services. Trends in Asthma Morbidity and Mortality. February 2002.
  5. National Center for Health Statistics. 2000 National Hospital Discharge Survey, Advanced Data No. 329. June 2002.
  6. US Centers for Disease Control and Prevention. Surveillance for asthma: United States, 1980-1999. Morbidity and Mortality Weekly Report 2002;51(SS01):1-13.
  7. National Heart, Lung, and Blood Institute. Morbidity and Mortality: 2002 Chart Book on Cardiovascular, Lung, and Blood Diseases. May 2002.
  8. Boulet LP, et al. Comparison of Diskus inhaler, a new multidose powder inhaler, with Diskhaler inhaler for the delivery of salmeterol to asthmatic patients. J Asthma 1995:32(6):429-436.

    Main Source: GlaxoSmithKline Press Release

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