St. Louis wheezed past all other cities last year to become the most dangerous place for people with asthma to live.

The Asthma and Allergy Foundation of America today named the St. Louis region the nation's worst, based on factors including an above-average death rate from asthma, a lack of smoke-free laws and high pollen counts.

Breathing hasn't been easy in St. Louis for years, but this is the first time the region reigns as the asthma capital, jumping up eight spots from 2007.

Doctors said they weren't surprised by the No. 1 ranking.

"We're seeing that more patients have severe asthma that really is disabling for them," said Dr. Mario Castro, a pulmonologist and professor at Washington University School of Medicine.

Nearly one in eight people in the St. Louis area has asthma, according to the St. Louis Regional Asthma Consortium, a group of doctors and public health officials who study the problem. In some schools in the region, one out of every five students has been diagnosed with the chronic lung disease.

Many more asthmatics may be missing out on medical care, doctors said.

"What I fear every day is this is a disease that's so common, that's very controllable and very treatable, yet there are a number of patients out there that are downplaying their symptoms and just living with it," Castro said. "All of a sudden they encounter something and they go into full-blown attack and can die."

Chronic respiratory disease, which includes asthma, is the fourth-leading cause of death in the St. Louis area. Asthma accounts for more than 12,000 emergency room visits in the region each year, according to the Missouri Department of Health and Senior Services.

While some people have asthma symptoms year-round, seasonal asthma peaks in the spring and summer because of the blooming grasses and trees. Last year was particularly challenging for asthmatics because above-average rainfall brought corresponding high mold and pollen counts.

At this time of year, cold and flu viruses can trigger asthma attacks. And secondhand smoke is a continuous culprit that irritates the lungs.

Moving away won't help, Castro said. Twenty or 30 years ago, doctors might have advised their local patients with asthma to move to a dry, warm climate like Arizona's. Today, doctors believe that allergens and asthma triggers are everywhere, and people become sensitized to the local triggers, wherever they live.

Asthma is marked by symptoms including shortness of breath, wheezing, chest tightness and persistent coughing. Doctors can generally control asthma symptoms with medications.

The asthma foundation knocked St. Louis for not having enough lung specialists to care for the population and for having a high percentage of people who lack health insurance.

Too many children with asthma aren't getting appropriate medical treatment, said Dr. Lee Choo-Kang, a pediatric pulmonologist at St. John's Mercy Medical Center in Creve Coeur.

"They don't have access to health care and they don't recognize how serious their asthma is," Choo-Kang said. Choo-Kang said he has seen children hospitalized who haven't received any previous medical attention for their asthma.

"Eventually we find this history of this child being medically disabled up until that point and no one really felt there was a problem," he said.

Parents should seek medical help for a child who wheezes, coughs at night or routinely sits on the sidelines during physical activities.

Patients can participate in about 10 clinical trials for asthma treatments in the St. Louis area. For more information, call 1- 866-362-5656 or visit vfh.wustl.edu.

bbernhard@post-dispatch.com | 314-340-8129