Some cities are just not favorable for people with breathing issues, especially those who have some form of chronic obstructive pulmonary disease (COPD). Smoking has an obvious impact on breathing issues or COPD, but what many people do not realize is that the environment also plays a big role. Here’s a list of America’s worst cities to live in with breathing issues.

1. Bakersfield, California
Some of the most polluted air in the country is breathed by residents of Bakersfield. This is measured on the basis of various factors. In terms of fine particulates, the area of Bakersfield ranks high in both annual and 24-hour averages. There is a lot of agriculture in this area that causes dust, pesticides, and fertilizers in the air, making it less breathable.

2. Oklahoma City, Oklahoma
People with asthma and COPD will face a hard time living in Oklahoma City; the death from asthma rate is also high over here. Thus, anyone with breathing problems should not consider shifting to Oklahoma City. The city also has the right rate of pollen, which adds to the worries of people with sensitive conditions. Furthermore, there are no laws pertaining to public smoking in Oklahoma that makes it even more difficult for people with breathing problems. Therefore, Oklahoma is an addition to the list of worst cities to live in with breathing issues.

3. Long Beach, California
The people of the city add to its woes, as there is a huge number of cars, factories, as well as shipping ports here. The weather that is mostly sunny and stagnant without a lot of rain adds to the problems. The city has a bowl-like topography, which further makes it difficult for polluted air to move out and clean air to come in. Although the condition is improved and it’s better than it was three-four decades back, the city still has a long way to go to make it safe for people with breathing issues.

4. Philadelphia, Pennsylvania
The quality of life in Philadelphia is good and the city also enjoys a breathtaking landscape. Yet, the city is marred by bad air quality, and is, thus, one of the worst cities to live in with breathing issues. The air is polluted due to various issues like public smoking laws. There is also high poverty in the city and the death rate due to asthma is alarmingly high.

5. San Jose-San Francisco-Oakland, California
Particulate matter and ozone are the two main reasons for bad air quality in the Bay Area. Ozone depletion causes some major problems during the summer. Likewise, winter air is polluted due to woodstoves and fireplaces. There is a program called Spare the Air that aims to educate residents about the perils of air pollution and how they can join the fight against pollution to keep the city healthy.