Richmond, Virginia once again has the title of America's "Asthma Capital."  For the fourth time over the past five years, the city leads the Asthma and Allergy Foundation's list of "The Most Challenging Places to Live with Asthma."  Meanwhile, it's getting a little tougher for those with asthma in Memphis, Tennessee.  That city now has second place -- up one spot from last year.  McAllen, Texas has made an even bigger leap, up to number three after ranking eighth in 2013.  Oklahoma City and Philadelphia round out the top five.  Fresno, California, which has the number seven spot, is the only Western city in the top ten.  The rankings are determined by a number of factors, including the prevalence of asthma, the number of asthma-related deaths and emergency room visits, air quality, pollen levels, and the number of asthma specialists in the area.

The Asthma and Allergy Foundation of America's 2014 Top Ten Asthma Capitals

1. Richmond, Virginia
2. Memphis, Tennessee
3. McAllen, Texas
4. Oklahoma City, Oklahoma
5. Philadelphia, Pennsylvania
6. Chattanooga, Tennessee
7. Fresno, California
8. Tulsa, Oklahoma
9. Chicago, Illinois
10. Detroit, Michigan