Asthma was once just an academic concern for Sylvia Brandt, who has spent years studying the chronic lung condition and calculating its tragic toll. Now, the threat is personal.

"One night I woke up and my daughter was really struggling to breathe. I thought, 'This was it: This is really the time that I might lose her.' It's an overwhelming feeling -- I can't describe it," said Brandt, a PhD research scientist at the University of Massachusetts, Amherst.

Brandt's daughter, Willow, who survived the attack and was diagnosed with severe asthma, is far from alone among her peers. In some schools in Springfield, Mass., which neighbors the Brandts' hometown of Amherst, as much as 40 percent of the student body suffers from asthma and the wheezing, coughing, breathlessness and chest tightness that come with it. The area is bordered by two major highways and is in close proximity to the Mount Tom coal-burning power plant.

"We're getting hit from all sides," said Brandt.

This is a nationwide concern. The number of asthma cases in the U.S. has doubled since 1980, and now affects 1 in 10 children, according to the U.S. Centers for Disease Control and Prevention. One of the major underlying causes -- emissions from coal-fired power plants, boilers and car tailpipes -- continues to flow mostly unabated, even as the Environmental Protection Agency struggles to regulate the fossil fuel industry and defend itself against right-wing critics who question the agency's agenda -- even its existence -- during this time of fiscal constraint.

Just last week, a close vote in the Senate halted an attempt to scale back rules unveiled by the EPA last year. These regulations would require industrial boiler and incinerator operators to install technology to reduce harmful air pollutants, such as mercury and soot; a requirement that opponents argue is very costly for businesses and risks the loss of more precious jobs and even plant closings.

"Any person who would say that the EPA should be eliminated or its ability to regulate reduced," Brandt said, "should have to sit in the emergency room holding the hand of a child who can't breathe."

The EPA, under the lead of Lisa Jackson (whose son also has asthma), is continuing to work to implement an array of updated clean air standards along with new regulations needed to achieve those standards. The Mercury and Air Toxics Standards (MATS), issued in December, and the Cross-State Air Pollution Rule are now two of the most hotly debated components. Coal and oil companies rest their opposition primarily on the rules' potential detriment to the economy. But if the new standards and rules hold, the EPA and environmental advocates maintain that the changes will significantly reduce the pollutants that Willow and so many other Americans breathe every day.

Overall, asthma is the number one chronic childhood disease, the leading reason for school absenteeism, and tops the list of causes for child hospitalizations and emergency room visits, according to the Asthma and Allergy Foundation of America. And not only do more children now have asthma, but these children also are typically experiencing more attacks and those attacks are becoming more severe, even deadly. In 2007, 3,447 Americans died from asthma, according to the CDC.

Environmental factors, including chemicals found in pesticides and plastics, appear to play a role in the rising epidemic. But more to blame, many scientists say, are soot (fine particles), ozone and other air pollutants that are addressed by EPA's pending legislation.

Evidence suggests that air pollution might not just trigger an asthma attack but could also increase the risk of developing the disease. This means that even if exposure to pollen, a cat or second-hand smoke makes a child cough and wheeze, pollution is often the root cause.

Some members of the fossil fuel industry and their supporters, however, continue to stall stricter regulations with dozens of letters and lawsuits. Two weeks ago, Sen. Jim Inhofe (R-Okla.), an outspoken climate change skeptic, sent a letter to EPA's Jackson that criticized a newly proposed greenhouse gas rule that would raise new automobile fuel economy requirements and cut carbon emissions from those vehicles in half by 2025. He noted that in addition to being a detriment to the nation's energy security, the standards would add an average of $2,000 to the cost of new cars in 2016, and would actually increase soot pollution from vehicles because people would simply drive more.

According to EPA estimates, the rule would reduce overall soot emissions, but only if the resulting reductions in fuel refining and distribution are also factored in. And when the improved gas mileage is taken into account, consumers would net a savings of $4,400 over the life of a new vehicle.

At a late February hearing, petitioners, including Massey Energy Co. and the state of Texas, also voiced their opposition to new standards that would regulate greenhouse gas emissions.

"The administration has long been talking about eliminating unnecessary regulations that could be harmful to the economy and job creation, and the greenhouse gas regulations should be at the top of that list," said Carlton Carroll, spokesperson for the American Petroleum Institute, another one of the petitioners. "The last thing we need now are more burdensome and unnecessary regulations that will create a drag on business efforts to invest, expand and put people back to work."

Among the clean air efforts under attack, the fate of the Cross-State Air Pollution Rule is of particular importance to many families in the Northeast; the measure would impose caps on sulfur dioxide and nitrogen oxide emissions that cross state lines. The so-called second-hand smog wafts in from the Midwest or Southeast and, upon arrival, can react with sunlight to form ground-level ozone and soot. The rule was temporarily stayed by a federal appeals court, pending an April hearing on the rule.

"Big corporate polluters have been working these delays for two decades now," said Peter Iwanowicz, director of the American Lung Association's Healthy Air Campaign. "They are using the current economic crisis to push their agenda and blocking the EPA."

"Tailpipe of the Nation"

Twelve-year-old Jake Conley lives in the small town of Raymond, Maine. The region is known for its pristine lakes, rugged beauty and vacation homes for city-dwellers who are desperate for a breath of fresh air. Yet Jake's mom, Lisa Conley, refers to Maine as the "tailpipe of the nation."

"We get pollution from other states," she said. "All of their stuff just blows in."

Lisa checks the local weather report daily. If the weatherman forecasts high ozone levels, she knows to be extra cautious for Jake, especially if there's soccer practice that day.

The asthma burden on the Conleys goes beyond the physical and emotional struggles. They own their own business -- a green energy one, appropriately enough -- so health insurance is expensive and the costs of asthma medication are "outrageous," said Conley.

After tallying up the average of four missed school days a year among asthmatics and five missed work days for their parents, as well as the medical costs and premature deaths, asthma cost the country $56 billion in 2007, according to the CDC.

The EPA estimates that MATS, the first national standards for reducing emissions of mercury and other toxic pollutants from power plants -- which has already triggered the planned closing of old coal-fire plants in the Midwest -- will prevent up to 11,000 premature deaths and 4,700 heart attacks each year by 2016, while also preventing 130,000 cases of childhood asthma symptoms.

In a December report, Columbia University public health researchers calculated the cost of implementing the new air quality regulations proposed or recently adopted by the EPA, including MATS, at about $195 billion over the next 20 years; the economic, environmental and health benefits amounted to over $1 trillion.

"The argument that the economy can't handle regulation is fundamentally flawed," said Brandt, who just published research that determined the annual cost associated with an asthma case in a pair of California cities to be 7 percent of the median household income, or about $4,000. "Our economy can't handle sick people. To have a healthy economy, we have to have a healthy population."

The targets of the new EPA rules are a source not only for pollutants that are related to asthma but that are also linked to global warming, and some of those pollutants are believed to contribute directly to both. So at the same time that the pollutants are causing attacks, they are also creating the conditions for things to get substantially worse for asthmatics like 10-year-old Jordan Alper.

Jordan's asthma behaves a bit differently than most kids'. He only needs asthma medication in the springtime, when plants start to blossom. "As people start deciding this is a wonderful time of year to open windows, that's when we generally close up shop here," said Lori Popkewitz Alper of Bedford, Mass., and Jordan's mother.

"Last year, we needed to start medicating him much earlier because it was so warm out," said Alper. "Last year, his asthma lasted a lot longer."

Scientists warn that as the climate warms, spring begins earlier and ends later. The prolonged season is also likely to bring more severe asthma through higher concentrations of pollen and other allergens, said Dr. Christopher Codispoti, an asthma expert at Rush University Medical Center in Chicago. And when temperatures rise, he added, so do ozone levels.

Overall, children with asthma are between two and six times more likely than non-sufferers to die from global warming-induced air pollution.

"Emotionally, this is very, very scary, and I know I'm not alone," said Alper. "We stand at our children's beds at night and listen to them breathe. You realize that's the breath of life and how quickly that can change."

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