(NBC News)– The sky above Bakersfield, California may look beautiful, but the polluted air puts it and another West Coast city, Los Angeles, at the top of the list of unhealthiest places to breathe in the United States according to the latest “State of the Air” report from the American Lung Association.

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

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.

“Particle pollution is especially risky for cardiovascular harm, like heart disease, stroke,” Nolen explains. “It’s also is greatly risky for people with diabetes and it causes lung cancer.”

Progress is being reported on the other side of the country.

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

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