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The 20 Worst Places to Live with COPD in the U.S.

Bakersfield, CA

If you're one of the 30 million Americans living with chronic obstructive pulmonary disease (COPD), you'll be only too well aware of the challenges of the condition. Every day, 10 people die of the disease. Tragically, most of those deaths are preventable. Adequate health care, education on how to manage the disease, clean air, and healthy housing can all go a long way to reducing premature death. While we're all aware of how smoking and certain genetic factors can exacerbate COPD occurrences, not everyone is as keenly aware of how environmental factors add to the risk. And we're not just talking air quality. As notes, poverty, lack of health insurance, pollen, smoking laws, and access to specialists can all play a significant part in the outcome of the disease. People living in cities with high unemployment and poverty rates are generally considered higher risk than those who live in affluent areas with good health care facilities, better housing, and greater access to specialists. And of course, areas with high pollution and smog levels are generally no-go zones for anyone who wants to live (and breath) free of COPD complications. While some cities are leading the way in clean air and low pollution, others are falling behind the pack... with catastrophic consequences for the nation's health. If you or a member of your family have COPD, these are the 20 worst places to live with COPD in the US.

Sacramento, CA

20. Sacramento, CA

Although Sacramento isn't doing too badly on year-round pollution levels, it's still one of the worst places to live in the US with COPD because of the high number of bad particle days caused by wildfires. Global warming is also playing a hand in things, with the city suffering more high ozone days than almost anywhere else in the country.

Carlsbad, CA

19. Carlsbad, CA

California might be making progress in the fight for clean air, but some of its cities are still lagging behind. When it comes to short term particle pollution, Carlsbad ranks as one of the worst cities in the US. Bad news for COPD patients, and bad news for anyone who likes to breathe in without endangering their health in the process.

Fairbanks, AK

18. Fairbanks, AK

In 2018, CBS ranked Fairbanks, AK as one of the worst US cities for air pollution. 2 years on, and thanks to the high levels of particle pollution caused by the city's predilection for wood burning stoves, the situation's no better.

Salt Lake City, UT

17. Salt Lake City, UT

59,401 people have COPD in Salt Lake City, a worrying number and one that's unlikely to improve unless the city starts to tackle its pollution problem. Salt Lake City's problems are exacerbated by the Wasatch Front’s unique geography, which in winter 'leads to periodic temperature inversions which trap cold air underneath a layer of warm air. This acts like a “lid” on the Salt Lake Valley—causing particulate pollution to double every day'. The situation's no better in summer, when pollution from cars and industry combine with high temperatures and bright sunshine to lead to harmful ozone levels.

Logan, UT

16. Logan, UT

Logan may only have 3,153 COPD patients, but considering it's only got 131,364 residents in total, that's still a concerning number. According to, it's not doing too badly on the ozone front, ranking a respectable 135 for high ozone days out of 229 metropolitan areas. Where it really falls down is in particle pollution, ranking 13 for 24-hour particle pollution out of 216 metropolitan areas.

Harrisburg, PA

15. Harrisburg, PA

In fairness, many cities across the US have been cleaning up their act over the past few years, with the result that air quality in many regions is better than it's been for decades. Not so in Harrisburg. This city in central Pennsylvania has experienced dramatic increases in air pollution in the last few years, to the extent that it now ranks number nine in the US for fine particle pollution, up 24 places from 2014. According to Kevin M. Stewart, director of environmental health for the American Lung Association in the region, most of the problem lies with the high number of commuters and industries in the area, both of which are responsible for releasing huge amounts of fumes into the air.

San Francisco, CA

14. San Francisco, CA

Thousands of residents in San Francisco have COPD. But they're not the only ones at risk from the area's poor air quality. Even those without COPD are still vulnerable to heart disease, strokes, and other lung conditions, all of which are known to be exacerbated by high levels of pollution.... something the Bay Area of the city has in abundance. Fortunately, the problem hasn't been ignored by the city's officials. For the past couple of years, the Bay Area Air Quality Management District has been hard at work via the Spare the Air program to educate residents about air pollution and inform them on how their actions affect air quality.

Los Angeles, CA

13. Los Angeles, CA

When it comes to risk factors for COPD, Los Angeles ticks every box. It's got factories, shipping ports, scores of people (all with gas-guzzling cars, naturally), and the kind of stagnant heat and bowl- like topography that strike fear into the hearts of lung disease patients. Ozone is one of the worst in the US, but it's not faring well on particle pollution either (i.e. the pollution caused by the tiny particles emitted by coal-fired power plants, diesel emissions, wildfires and wood-burning devices.that can lodge deep in the lungs and result in COPD, asthma attacks, heart attacks and strokes). But according to Jonathan M. Samet, MD, director of the Institute for Global Health at the University of Southern California, in Los Angeles, it's not all bad news. "It’s a pretty nice day and I can see downtown L.A," he says. "That would not have been the case 30 or 40 years ago."

Phoenix, AZ

12. Phoenix, AZ

It's dry, it's hot, and it's a nightmare for COPD patients. Where are we talking about? Phoenix, AZ, a place where 89 percent of residents have skipped the lesson on ride shares to travel solo to work each day. The result? Fumes, pollution, smog, and a lot of very unhealthy residents. “Phoenix residents should be aware that we’re breathing unhealthy air, placing our health and lives at risk,” said American Lung Association director of advocacy, Joanna Strother. “We’re heading in the wrong direction when it comes to protecting public health.”

El Centro, CA

11. El Centro, CA

Asthmatics and COPD patients have El Centro's location in the Southern California Border Region to thank for their breathing problems. With two international border crossings to its name, El Centro experiences a steady stream of traffic on both sides from dusk to dawn. The region is also bothered by searing temperatures, dust-dry conditions, and high level of agriculture, none of which make the wish list for anyone with lung conditions.

Denver, CO

10. Denver, CO

According to, over 300,000 of the Denver-Aurora metro area’s 3.5 million residents have asthma. And where asthma goes, COPD soon follows. Although air quality has improved in recent years, the high levels of ozone and smog are a veritable nightmare for anyone with a tendency towards breathing issues.

Las Vegas, NV

9. Las Vegas, NV

Since 1996, the number of smoggy days in Las Vegas has fallen by 17. Good news, but not good enough to negate the fact it's still one of the most polluted cities in the US. Although Nevada is on a mission to cut ozone to zero or near-zero by 2050, it's unlikely to come soon enough for the 342,326 seniors that live in the area, all of whom are already at an increased risk of COPD and smog-related breathing problems due to their advanced age.

Pittsburgh, PA

8. Pittsburgh, PA

Pittsburgh is located in one of the country's asthma belts. Not great news for asthma sufferers, and not great news for COPD patients either, considering both diseases are triggered by many of the same factors. The coal and steel industry can take much of the blame for the air quality in the region, which currently ranks eighth in annual particle pollution, 14th for 24-hour particle pollution, and 26th for ozone.

Louisville, KY

7. Louisville, KY

If you want to live somewhere with clean air, try to avoid valleys. More specifically, try to avoid valleys like the one Louisville in set in. Surrounded by hills on all sides, the city keeps a vice- like grip on dirty air, concentrating the levels of pollutants and making deep breathing less of a practice in meditation and more of a practice in risking your life.

San Diego, CA

6. San Diego, CA

In fairness, the air quality in San Diego is better now than it used to be. Compared to the 1990s, it has 52 fewer high smog days each year. But let's face it, it's still not great. As well as being home to 866,445 current or former smokers (a known risk factor for COPD), it has the sixth worst ozone pollution in the US - and it's getting worse by the day. The last couple of years has witnessed a dramatic rise in dangerous ozone pollution in the city, with the number of unhealthy ozone days growing by 42 percent since 2015, averaging 45 unhealthy days a year.

Springfield, MA

5. Springfield, MA

Known as the 'Asthma Capital of the US', Springfield, Massachusetts, is not the place to go if you value your lung health. With one of the highest rates of asthma prevalence in the US and more asthma-related emergency room visits than you could credit, something's clearly afoot. High level of industry, pollution, and diesel emissions all contribute to a problem that seems to be getting worse by the year.

Modesto, CA

4. Modesto, CA

Over 20,000 people already have COPD in Modesto. If it doesn't start cleaning up its act, there'll soon be even more. Surrounded by farmland, it's a victim of chronic agricultural pollution. While several initiatives have been launched to improve air quality (including setting strict guidelines around the burning of trash and yard waste), it's still got a long way to go, at least according to, who rank it fourth in the US for short-term air particle pollution and seventh for ozone.

Fresno, CA

3. Fresno, CA

Over half a million people live in Fresno, of which tens of thousands are COPD patients. According to, the problem lies in the unholy trinity of traffic, sunshine, and agriculture. Like Bakersfield and Visalia, the city also suffers from the dual threat of heavy industry and a smog-trapping location in the bowl-shaped San Joaquin Valley. Although ozone levels have dipped slightly in the past few years, they're still a long way from meeting national air quality standards.

Visalia, CA

2. Visalia, CA

Just a short distance from Bakersfield (our number one offender for air quality), lies Visalia. Like Bakersfield, the area boasts a startlingly high number of COPD cases, and little wonder. Visalia ranks second among U.S. cities for ozone and third for year-round air particle pollution. Both problems are exacerbated by the city's position in the San Joaquin Valley, an area with high levels of both agriculture and industry - neither of which are exactly conducive to clean air. Add to that the methane emissions from the industrial dairies (Tulare County is home to 1 million cows, over double the human population), and you're looking at a no-go zone for anyone who values healthy lungs.

Bakersfield, CA

1. Bakersfield, CA

If you have COPD, make it your life's mission to avoid coming within striking distance of Bakersfield, CA. Of its 874,589 residents, a mammoth 27,545 have been diagnosed with COPD. Considering around half of COPD cases go unreported, we're looking at a real-time figure of twice that. The problem lies in its location in the San Joaquin Valley, an area where the high levels of agriculture "whips up" dust, pesticides, and fertilizers before depositing them onto the unlucky residents below. The fact that it's surrounded by mountains on three sides doesn't help, either - with no means of escape, any smog and pollution is essentially 'trapped' in the valley. Oil and gas production in the area also plays a role in the city's poor air quality, with several facilities having been caught in violation of the Clean Air Act for greenhouse gas emissions.

Liz Flynn

Written by Liz Flynn

Liz Flynn has worked as a full-time writer since 2010 after leaving a career in education. She finds almost all topics she writes about interesting, but her favorite subjects are travel and food. Liz loves the process of researching information, learning new things, and putting into words what others who share her interests might like to read. Although she spends most of her time writing, she also enjoys spending time with her husband and four children, watching films, cooking, dining out, reading, motorsports, gaming, and walking along the beach next to her house with her dog.

Read more posts by Liz Flynn

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