Metro Denver and Fort Collins once again ranked high on the list of the worst U.S. cities for air pollution, reaching seventh and 18th place, respectively, based on ozone levels, in the American Lung Association’s annual “State of the Air” report, released Thursday.

Only cities in California and Arizona were ranked worse than the Denver-Aurora metro area on the ozone pollution list, with metro Denver rising from its eighth-place position last year and 10th place in 2020.

Fort Collins dropped one spot to 18th place on the ozone pollution list, though it’s still higher than the 19th-place position the city held in 2020.

Breathing ozone irritates the lungs, potentially causing asthma attacks, harming lung development in children, and even proving deadly, according to the American Lung Association.

Most of the metro area — Denver, Adams, Arapahoe, Boulder, Douglas and Jefferson counties — received an “F” grade for high ozone days, as did the other most-populated counties on the Front Range, including Larimer, Weld and El Paso.

The rankings come as the Environmental Protection Agency is on the verge of downgrading the Denver region again, from “serious” to “severe” violators of federal ozone standards, a move that would result in higher gas prices and requires more businesses to apply for emissions permits under the federal Clean Air Act.

The “State of the Air” report’s ratings for short-term particle pollution were better, with only Denver, Boulder, Larimer and Weld counties receiving “F” grades, while Arapahoe and Pueblo counties scored an “A,” El Paso received a “B,” Adams got a “C” and Douglas earned a “D.”

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Denver, Boulder and Douglas counties did still receive passing marks for average annual particle pollution levels.

The American Lung Association warned that particle pollution, which includes particles smaller than 1/30th the diameter of a human hair, can get into your body and “can cause early death and heart attacks, strokes and emergency room visits.”

The poor quality of the Front Range is consistently ranked high in the nation, though many residents across the U.S. are dealing with air pollution.

The top four metropolitan areas on the list of worst ozone pollution were in California — Los Angeles, Bakersfield, Visalia and Fresno — with Phoenix coming in fifth and San Diego at sixth place. Houston, Sacramento and Salt Lake City rounded out the top 10.

“More than four in 10 Americans live where the air they breathe earned an ‘F’ in ‘State of the Air’ 2022,” the American Lung Association wrote in the report.

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