Being able to breathe comfortably is important for everyone. Yet, those with asthma symptoms can find it difficult with shortness of breath, chest pain, and wheezing. For many with asthma, knowing what can cause asthma symptoms can impact the quality of life. Avoiding environments that can increase the likelihood of triggering symptoms can be a way to better manage asthma.

Here are the five U.S. cities with the most eosinophilic asthma triggers:

1. Dayton, OH
Those who live in Dayton can find themselves with higher asthma triggers than most other cities. The city is in the Ohio Valley, which contains conditions that trigger asthma symptoms far greater than other regions. The Ohio Valley contains a higher concentration of pollen. When that pollen enters the lungs of an asthma person the result can be dangerous. Often, pollen can lead to long-term health problems. The pollen is at the highest concentration during the spring season. Seasonal allergies are very common for those who live in Dayton and can impact their quality of life greatly.

2. Greensboro, NC
When it comes to Greensboro, the ragweed pollen count is through the roof. Allergists also note a large number of green trees don’t directly contribute to the pollen. The area is also situated between the Smoky Mountains and the abundance of trees. Together, they result in a concentration of ragweed pollen that can trigger asthmatic symptoms. Another issue for the city is the pollution of the ozone. The city ranks as one of the most ozone-polluted cities in the country, resulting in an increase in asthma symptoms from residents.

3. Springfield, MA
When it comes to asthma triggers, Springfield ranks highest with the largest amount of patients visiting the emergency room for asthma impacted visits. The pollution in the city, combined with the higher than average pollen amounts makes symptoms much more severe than in any other city. Often, patients need severe asthma medication to improve their quality of life living in Springfield. Higher than typical poverty rates also impact the city residents. Residents with lower access to healthcare are more likely not able to get the care they need to help manage asthma symptoms.

3. Philadelphia, PA
Residents in Philadelphia are more likely to experience symptoms of asthma due to local issues. Pollution in the area is significantly high with harmful gases and small particles decreasing the quality of the air. Pollen is also a contributing factor, and during the season of high pollen, people can experience shortness of breath and chest pains. Due to poverty in the area, more people don’t seek the treatment they need to live a quality life. Housing issues with high levels of dust can also contribute to triggering symptoms for residents.

4. Cleveland, OH
For those with asthma, living in Cleveland can trigger symptoms higher than in many other areas. Allergens and pollution from the city industry are significant factors in causing shortness of breath, and wheezing for many, especially children. Seasonal pollen levels can also factor into increased symptoms of asthma. When it comes to housing in the city, houses tend to be much older than in other regional areas. Household dust and dust mites are much more likely to exist and affect residents. Limited access to healthcare can prevent children and adults from seeking the care they need to live healthy lives. Often, residents wait to seek medical help. Doing so results in more visits to the emergency rooms and prolonged suffering of asthmatic symptoms.