Despite continued improvement in air quality across the nation, the American Lung Association found that the Los Angeles-Long Beach area still experiences “dangerous” amounts of particle and ozone pollution, which increases the risk of premature death, cancer, asthma attacks and reproductive harm, among other serious health issues.

Wednesday, the ALA released its 18th annual “State of the Air” report, which detailed the findings of data collected from 2013 to 2015. The national air quality “report card” found that 125 million Americans, roughly 38 percent of the population, live in counties with unhealthy levels of either ozone or particle pollution.

“Even with ongoing improvements, too many people in the United States live where the air is unhealthy for them to breathe,” Harold P. Wimmer, national president and CEO of ALA, said in statement. “This is simply unacceptable. Everyone has a fundamental right to breathe healthy air. Our nation’s leaders must do more to protect the health of all Americans.”

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The report analyzes particle pollution through average annual particle pollution levels and short-term spikes. Particle pollution results from wildfires, wood-burning devices, coal-fired power plants and diesel engines. The microscopic particles lodge deeply in the lungs and can cause asthma attacks, heart attacks, strokes and lung cancer.

Los Angeles-Long Beach ranked first on the Top 10 Most Ozone-Polluted Cities, ninth on the Top 10 U.S. Cities Most Polluted by Short-Term Particle Pollution and fifth on the Top 10 U.S. Cities Most Polluted by Year-Round Particle Pollution.

While the Los Angeles-Long Beach area ranks number one for ozone pollution, the most recent data shows that ozone pollution levels are the lowest they’ve ever been.

Officials warn that inhaling ozone pollutants act like a sunburn on the lung and can result in coughing and asthma attacks and can shorten lifespans.

Other California cities to frequently receive low scores include Bakersfield, Fresno, Modesto, Sacramento, San Francisco-San Jose, San Diego-Carlsbad, San Luis Obispo and El Centro.

While Los Angeles, and much of California, did not score well, the ALA reported that overall air quality continues to improve across the country.

Officials said in a statement that the largest improvement in air quality resulted from the continual reduction in high ozone days and levels of year-round particle pollution.

“This year’s State of the Air report is a testament to the success of the Clean Air Act, which has reduced air pollution in much of the nation,” Wimmer said. “As a result, Americans’ lung health is far better protected today than it was before the Clean Air Act health protections began nearly five decades ago. However, this report adds to the evidence that the ongoing changes in our climate make it harder to protect human health. As we move into an even warmer climate, cleaning the pollutants will become ever more challenging, highlighting the critical importance of protecting the Clean Air Act.”

The Clean Air Act, which became federal law in 1970, regulates air emissions from stationary and mobile sources, such as vehicles.

The law allows the Environmental Protection Agency to set the National Ambient Air Quality Standards, which regulate emissions of hazardous air pollutants and help protect public health.

“The Clean Air Act is the most important tool in the fight for healthy air; it has successfully saved lives and improved health by driving emission reductions for more than 47 years, as ‘State of the Air’ continues to document,” Wimmer said. “We urge President Trump, EPA Administrator Scott Pruitt and members of Congress to fully fund, implement and enforce the Clean Air Act for all pollutants, including those that drive climate change and make it harder to achieve healthy air for all.”

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President Trump’s proposed budget cuts to the EPA would decrease funding for the Clean Air Act from $227 million to less than $160 million.

The top cleanest cities in the U.S. are Burlington-South Burlington, Vt., Cape Coral-Fort Myers-Naples, Fla., Elmira-Corning, N.Y., Honolulu, Hawaii, Palm Bay-Melbourne-Titusville, Fla. and Wilmington, N.C.