Nearly 28 million people in the U.S. have asthma, or about one in 12 people — and depending on where you live, the condition may be more difficult to manage.

The Asthma and Allergy Foundation of America (AAFA) recently released its Asthma Capitals report, which ranks the 100 most populated U.S. states based on how challenging they are for people with the chronic respiratory disease.

"This is not a report about ‘bad’ cities for asthma — rather, it is a report that indicates the factors that can make living with asthma more challenging," Kenneth Mendez, president and CEO of the AAFA in Virginia, told Fox News Digital via email.

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The report designates "asthma capitals" based on the prevalence of the disease, the number of asthma-related emergency room visits, and asthma-related deaths.

"The cities at the top of the report tend to score higher than average in at least two of these categories," Mendez noted. 

"High rates of hospitalization or death due to asthma indicate a lower quality of life for people with asthma in these cities."

This report also acknowledges that where people live can significantly impact their health, Mendez said. 

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"Social, economic and environmental disadvantages play a role in determining asthma outcomes," he noted. 

"Many of the top asthma capitals are also facing major challenges and inequities that lead to health disparities."

Risk factors for asthma — including air quality, poverty, access to specialists, tobacco policies, use of medications and lack of health insurance — are also factored into the report.

Added Mendez, "We see the report as a way to highlight factors impacting asthma."

The AAFA identified the following 20 cities as the top "asthma capitals."

The full list of 100 top asthma capitals is listed in the report, which can be accessed from the AAFA’s website.

For those with asthma who live in one of the more challenging locations, the AAFA recommends taking the following steps to make the condition more tolerable.

To keep asthma under control, this plan should include information about medications, ways to recognize worsening symptoms and steps to take in an emergency.

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Mendez noted that getting vaccines for respiratory infections such as the flu, COVID-19, respiratory syncytial virus (RSV) and pneumonia can help to manage asthma symptoms.

"We spend 90% of our time indoors, so it is important to take steps to improve indoor air quality," Mendez told Fox News Digital. 

"These can include using certified asthma- and allergy-friendly air cleaners, and ensuring that cleaning products reduce allergens and are free from airway irritants."

This may include wearing a mask in crowded places, washing hands properly and avoiding contact with sick people, according to Mendez.

Getting the optimal amount of rest, drinking plenty of water and eating healthy foods can help make asthma more tolerable, per the AAFA.

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"There are treatment options available that can help prevent the risk of an asthma attack, thus making it possible to live with this chronic lung disease," Mendez said. 

"Patients should speak with their health care team to determine what plan is best for them."