The American Lung Association says 125-million people live in areas of the country with unhealthy levels of air pollution.

The sky above Bakersfield, California may look beautiful, but the polluted air sends it and another west coast city, Los Angeles, to the top of the list of unhealthiest places to breathe in the U.S.

That's according to the latest "State of the Air" report from the American Lung Association.

Janice Nolen with the American Lung Association says, "This is our 18th annual report, so we've seen a lot of improvements. But we're also seeing some trends that are scary."

Some cities, mostly in California, Utah, and Nevada, are seeing spikes in particle pollution from wildfires, factories and vehicles. 

Pollutants can cause severe asthma attacks, particularly in vulnerable children. And that's not all. 

Janice Nolen says, "Particle pollution is especially risky for cardiovascular harm, like heart disease, stroke. It also is greatly risky for people with diabetes and it causes lung cancer."

On the other side of the country -- progress. 

Cities with the cleanest air are nearly all on the east coast including Burlington, Vermont and Naples, Florida.

The only one out west? Honolulu, Hawaii.

Find out where your city ranks in the "State of the Air" report.