Summertime, and the living is hardly easy for asthma sufferers in metro Atlanta. Ask Joelle Hodges.

"I think I'm allergic to Atlanta," said the 30-year-old Kennesaw resident. Last year, she experienced cold symptoms that lingered for months before she was diagnosed with asthma. Moving to the city three years earlier didn't help.

Atlanta ranks fourth this year among worst cities for asthma sufferers, according to the Asthma and Allergy Foundation of America, a nonprofit that ranks asthma capitals annually based on factors such as higher-than-average pollen levels, air pollution and lack of smoke-free laws.

Not only do asthmatics such as Hodges feel the effects in their lungs, but also their pocketbooks.

The U.S. Food and Drug Administration recently discontinued the manufacture and sale of albuterol (a quick-acting drug that opens airways) asthma inhalers that contain chlorofluorocarbons, or CFCs. Chemicals in the inhalers damage the Earth's ozone layer, and the FDA wants them replaced with environmentally friendly HFA (hydrofluoroalkane) inhalers by Dec. 31. The new inhalers cost $45 to $65, and they won't be available in generic form for years.

"It's very frustrating," said Hodges, who felt an immediate pinch when her albuterol jumped from $5 to $30. She takes five medications to control asthma symptoms and averages more than $120 a month in prescriptions. "I feel like the asthma and the medications have taken over my life," she said.

Hodges is not alone. One in three asthma patients uses a rescue inhaler at least daily, and 73 percent use a rescue inhaler at least once a month, according to an AAFA survey.

Since there is no cure for the disease, medications are the primary means to manage asthma symptoms such as chronic coughing, wheezing after activity and chest tightness. With proper treatment and avoidance of triggers such as pollen, poor air quality, dust and stress, the nation's 20 million children and adult asthma sufferers can lead normal lives.

But that's hard to do when you live in one of the nation's asthma capitals.

Sun plus emissions: A dangerous mix

Two types of air pollution are especially dangerous to breathe: ozone (smog) and particle pollution (soot). Atlanta has plenty of both. Ozone is an invisible gas that is typically formed when sunlight reacts to vapors emitted when fuel is burned by cars and trucks, factories, power plants and other sources. It usually peaks from May through October, when temperatures are highest and sunlight is strongest.

Also, prevailing wind patterns blow emissions from coal-burning electrical power plants in North Georgia toward the city, and the plants pollute the metropolitan area with particulate matter that can worsen respiratory disorders, as well as trigger heart attacks, strokes, irregular heartbeats, lung cancer and premature births.

While smog causes inflammation in everyone, people with breathing problems feel the effects more severely. Extreme weather changes and high temperatures accelerate the reactions, said Cherry Wongtrakool, a pulmonologist at Emory University Hospital.

No wonder, then, that as the heat rises and that familiar brown cloud of smog settles over metro Atlanta, more adults and children wind up in emergency rooms gasping for air, according to researchers at Emory's Rollins School of Public Health who are studying air quality and health.

Every city has a variety of risk factors, so you can move, but you cannot hide from asthma, experts agree. The best defense is a good management plan that begins with early diagnosis.

"People are living with stuffy lungs just like they're living with stuffy noses," said Ann-Marie Brooks, medical director of the Children's Healthcare of Atlanta Asthma Center.

'A walking time bomb'

Brooks said that asthma remains largely underdiagnosed because people ignore the symptoms. If a person becomes short of breath each time he walks more than five minutes, he tends to stop walking more than five minutes instead of telling his doctor, she said. Over time, symptoms left untreated diminish lung capacity and decrease quality of health.

"You're a walking time bomb," Brooks said of people unaware of their decreased lung function. "At any moment, your airways can close down on you, and if you don't have the appropriate medication, you can die."

About 120 deaths occur in Georgia each year from asthma.

Virginia-Highland resident Lisa Waller, 30, learned to control her asthma during childhood (she was diagnosed at age 6) and monitors air quality indexes and adjusts her activities to avoid irritants such as pollens, poor air quality, high humidity and viral colds.

"You get better over time understanding your symptoms and your triggers," Waller said.

BY THE NUMBERS

Every day in America:

40,000 people miss school or work because of asthma.

30,000 people have an asthma attack.

5,000 people visit the emergency room because of asthma.

1,000 people are admitted to a hospital because of asthma.

11 people die from asthma.

Source: Asthma and Allergy Foundation of America

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ASTHMA FACTS

> Asthma is characterized by inflammation in the air passages resulting in the temporary narrowing of the airways that transport air from the nose and mouth to the lungs.

> Symptoms are caused by allergens or irritants that are inhaled into the lungs, resulting in inflamed, clogged or constricted airways. Symptoms include difficulty breathing, wheezing, coughing and tightness in the chest.

> There is no cure for asthma, but it can be managed through treatment.

> Asthma has a genetic component. If only one parent has asthma, chances are 1 in 3 that each child will have asthma. If both parents have asthma, there's a 70 percent chance that their children will have asthma.

> Triggers include smoke (from cigarettes, pipes, cigars, fireplaces, grills and burning wood), colds and flu, exercise, weather (rain, wind, low temperatures or sudden weather changes), pets, roaches and other pests, strong odors, mold, dust mites and air pollution.

Source: Children's Healthcare of Atlanta

HOW ASTHMA IS DIAGNOSED

There is no single test to diagnose asthma, so your doctor will use a combination of medical history, patient interview and physical exam to make a determination. Be specific and detailed when answering the following:

> Is there a family history of allergy and/or asthma?

> What are the symptoms and when did you first notice them?

> When do they occur? What causes the symptoms or makes them worse (smoke, exercise, allergens, humidity, crying/laughing, etc.)? Is there any pattern to them?

> What are the frequency and severity of the symptoms? Do they limit or interfere with daily activities? Limit physical activity? Disrupt sleep?

> Have you needed to go to the emergency room or hospital because of symptoms?

>How are the symptoms managed?

Source: American Academy of Allergy, Asthma and Immunology

TREATING THE SYMPTOMS

Prescription medications vary in price based on insurance coverage.

> Bronchodilators —- rescue medication that relaxes the bronchial tubes and allows for easier breathing (Proair HFA, Proventil HFA, Ventolin HFA)

> Inhaled steroids (powders and puffers) —- controller medication that reduces inflammation (Flovent HFA, Qvar HFA, Pulmicort, Asmanex)

> Oral asthma controllers (tablets) —- reduce inflammation (Singulair, Zyflo)

> Anti-inflammatory and bronchodilator —- combination medication that opens airways and reduces inflammation (Advair, Symbicort)

> Steroid medication —- used for severe asthma symptoms (Prednisone)

> Immunotherapy (allergy shots) —- treats allergic asthma conditions

> Injection therapy —- blocks the allergic antibody (Xolair)

> Over-the-counter medications —- dilate the bronchial tubes (opens the airways), but they are potentially dangerous and are typically not recommended for asthma treatment (Primatene, Bronkaid)

Source: Dr. Kevin Schaffer, Atlanta Allergy & Asthma Clinic

TIPS TO PROTECT YOURSELF —- AND OTHERS

The American Lung Association encourages all Americans to get involved in the fight for cleaner, healthier air:

> Drive less, drive smart. Walk, bike or car pool. Combine trips and use buses, subways, light-rail systems, commuter trains or other alternatives to driving. Fill up your gas tank after dark. Gasoline emissions evaporate as you fill up your gas tank and contribute to the formation of ozone, a component of smog. Filling up after dark helps to keep the sun from turning those gases into air pollution.

> Plan your day. Check air quality levels and air pollution forecasts in your area. Sources include radio and TV weather reports, newspapers and online at www.epa.gov/airnow.

> Help out at home. Don't burn wood or trash. Burning firewood and trash are among the major sources of particle pollution in many parts of the country. If you must use a fireplace or stove for heat, convert your wood stoves to natural gas, which produces far fewer emissions. Use hand-powered or electric lawn care equipment rather than gasoline-powered.

> Limit outdoor exercise. Avoid exercising outdoors when pollution levels are high. Walk indoors in a shopping mall or gym or use an exercise machine. Always avoid exercising near high traffic areas. Limit the amount of time your child spends playing outdoors if the air quality is unhealthy.

Source: American Lung Association