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To analyze the long-term trends in pollen counts and asthma-related emergency department visits (AREDV) in adult and pediatric populations in the Bronx. Daily values of adult and pediatric AREDV were retrospectively obtained from three major Bronx hospitals using ICD-10 codes and pollen counts were obtained from the Armonk station from 2001–2020. Wilcoxon Ranked Sum was applied to compare median values, while Spearman correlation was employed to examine the association between these variables, for both decades and each season. The median value of pediatric AREDV increased by 200% from the 1st to 2nd decade ( p  &lt; 0.001) and AREDV peak shifted from predominantly the spring season in the 1st decade to the fall and winter seasons in the 2nd decade. Seasonal patterns were consistent over 20 years with summer AREDV lower than all other seasons (9 vs. 17 per day) ( p  &lt; 0.001). Spring tree pollen peaks were correlated with AREDV peaks (rho = 0.34) ( p  &lt; 0.001). Tree pollen exceeding 100 grains/m 3  corresponded to a median of 19.0 AREDVs while all other tree pollen (0 − 99 grains/m 3 ) corresponded to a median of 15.0 AREDVs ( p  &lt; 0.001). AREDVs sharply declined in 2020, coinciding with the emergence of COVID-19. Pollen and AREDVs peak earlier in the spring and are more strongly interconnected, while asthma rates among children are rapidly rising, particularly in the fall and winter. These findings can advise targeted awareness campaigns for better management of asthma related morbidity.

Trends in seasonal pollen and asthma-related morbidity among adults and children in a U.S. high-density urban center, 2001-2020