The "A" in Atlanta might as well stand for asthma, according to the Asthma and Allergy Foundation of America.

The nonprofit patient organization says that for asthma sufferers, Atlanta is the worst U.S. city to live in.

Seattle ranks best -- or, in this case, least bad -- on the group's list of the 100 "most challenging places to live with asthma."

The 10 worst asthma cities, according to the AAFA, are:

1. Atlanta (last year: 4th)

2. Philadelphia (last year: 3rd)

3. Raleigh, N.C.

4. Knoxville, Tenn.

5. Harrisburg, Pa.

6. Grand Rapids, Mich.

7. Milwaukee, Wis. (last year: 5th)

8. Greensboro, N.C. (last year: 7th)

9. Scranton, Pa. (last year: 1st)

10. Little Rock, Ark.

Atlanta earns its "worst" score from the city's high asthma death rate, high pollen levels, and severe air pollution.

The AAFA also cites Atlanta's "worse-than-average" public smoking laws, although the city does ban smoking in 80 percent of hotel rooms and in bars and restaurants that allow access to minors (except in private, separately ventilated rooms).

The idea behind the ranking is to warn Americans that across the nation, asthma rates continue to climb.

Growing Problem

In the last 20 years, asthma prevalence has doubled, says Derek Johnson, MD, director of pediatric allergy at Temple University, in a news release.

"People can't just move away from their asthma since every city in America has a variety of risk factors," Johnson says.

Indeed, even Seattle flunks some AAFA tests. The city gets "worse than average" scores in asthma prevalence and only "average" ratings for air quality, uninsured rates, school inhaler-access laws, and number of asthma specialists.

"People should work with an asthma specialist to have a good asthma management plan no matter where they live," Johnson says.

By Daniel J. DeNoon, reviewed by Brunilda Nazario, MD

SOURCES: Asthma and Allergy Foundation of America: "2007 Asthma Capitals -- The Most Challenging Places to Live with Asthma," AAFA web site. American Nonsmokers' Rights Foundation web site. News release, AAFA.