Suddenly shy, Erin McCloskey dips her head, her silky brown hair falling across her face, and speaks quietly.
"You can barely breathe at all," she says. "And it's sometimes hard to get sentences out because you're always trying to take a breath."
Erin, 13, was diagnosed with asthma soon after her first birthday, when an odd cough led to her first hospitalization.
"I thought, 'She'll be in. We'll get her situated. We'll get her on the right meds. This will be the end of it,' " says her mother, Natalie.
Two months ago, Erin was hospitalized for the 11th time.
With three of their six children diagnosed as asthmatics, Natalie and Sean McCloskey of Burlington County firmly believe the future of their family's health is in the hands of federal officials who are deciding whether - and how much - to tighten air standards for smog.
Smog is one of the nation's most widespread and deadly air pollutants. It exacerbates asthma.
Also known as ground-level ozone, smog is formed when pollutants from tailpipes and industry smokestacks, plus gasoline vapors and other chemicals, react with sunlight and heat.
It's especially bad in places that have a lot of people and a lot of cars, and are downwind from factories and power plants. And the particular weather patterns here push the Philadelphia region high on various rankings of bad locations for asthmatics.
Smog doesn't cause asthma. But it can chemically "sear" lung tissue, says Robert Tweel, board chairman of the American Lung Association of the Mid-Atlantic.
Breathing it can cause chest pain, coughing, throat irritation and congestion, and further reduce asthmatics' lung function.
"People will have more frequent episodes, more severe episodes, the more smog they are exposed to," says Kevin Stewart, the association's director of environmental health.
Levels commonly found in the United States, he says, can "significantly harm people's health," causing "millions of lost school and work days, hundreds of thousands of asthma attacks, and thousands of premature deaths."
It's not a new problem. The nation has been attempting to regulate smog and other air pollutants since creation of the Clean Air Act in 1970.
Standards took effect well before Erin was born in 1994, and have been revised since. Smog has indeed been reduced: Federal standards (Codes Orange and Red) were typically exceeded in the Philadelphia region nearly 40 days each summer in the late 1990s, vs. 21 days this season.
Yet new scientific studies on smog, thousands of pages worth in the last decade alone, have increased the concern.
"The more we get to know these pollutants, the less we like them," says EPA spokesman John Millett.
The year Erin turned 3, the EPA adopted stricter standards that were swiftly challenged by industry.
In 2001, when she was 7, the U.S. Supreme Court ruled in the agency's favor - and, further, directed that only public health, not costs, be considered when setting acceptable pollution levels.
Various regulatory changes since then are credited with nearly halving the number of days in the Philadelphia region that exceeded the federal limit.
Faced with more lawsuits, this time from groups arguing that a mandatory five-year review of the 10-year-old standards was long overdue, the EPA this year proposed limits that were tighter still - although not, as critics point out, as strict as its own scientific advisory committee recommended. Public hearings were held in several cities over the last month.
In Philadelphia on Aug. 30, health officials, environmental advocates, industry spokesmen and government representatives weighed in.
"If you have an asthmatic member of your family, you will understand the passion of my testimony," said Joseph O. Minott, executive director of the Clean Air Council in Philadelphia.
Industry groups pointed out that air quality nationwide will continue to improve as states implement the current standards, and argued that meeting stricter limits could cost billions of dollars.
Amid it all, Natalie, Sean and all six McCloskey children trooped into the Warwick Hotel meeting room. Mom took the microphone and held up a plastic bag full of bottles.
"On a good day, we have to stop what we are doing to administer the medications in this bag at least four times," she told the panel.
The lung association's Stewart says about one in 11 children in the region has asthma. For the most severely afflicted, the disease defines their day.
The McCloskeys don't buy tickets for events in the summer. If Erin or her sisters Dacey, 5, and Annalivia, 3, can't breathe, the money would be wasted. Most of the time, they keep the windows of their Delran home closed tight against the outside air.
Sean Jr., the eldest child at 15, feels both protective of his sisters and helpless. "It's very scary," he says. "Just standing by and watching them suffer . . . "
If Erin is having difficulty breathing, "I'll do something for her. I'll get her a drink."
Says Erin, a cheerleader: "People think that asthma is not serious and I want them to know it can be serious and don't think we're all wimps because we're stepping out of activities like running or swimming."
Most frightening for her mother is not knowing when the next attack will come.
Perhaps the scariest was when Erin coughed herself unconscious as a toddler.
July was more typical, with Erin just not feeling well at first. She wound up spending five days in the hospital. Doctors suspect she developed immunity to her medication.
"What happens if she becomes immune to the 'rescue' medication she now takes?" Natalie McCloskey told officials as she recounted the incident at last month's hearing.
Other pollutants are factors in asthma attacks. The EPA adopted new standards for particulate matter late last year; in December, New Jersey and Pennsylvania joined a multistate legal challenge, saying the standards do not adequately protect public health. And the agency is beginning to revisit its standards for oxides of nitrogen.
If the new smog standards are adopted, 13-year-old Erin would likely be in her 30s before they could be met.
"We've done everything we can to help ourselves," says her mother, who works part time at a YMCA day-care center so she can be available to her children when needed. "They're on all the medications. They see all the specialists. We do what we can."
More on Smog
Both the current and proposed standards for ground-level ozone are complex. Fact sheets and details are online.
To submit a comment
The U.S. Environmental Protection Agency will accept comments through Oct. 9.
Submissions should be marked docket ID No. EPA-HQ-OAR-2005-0172 and submitted via:
Local and national backgrounders on smog are posted at http://go.philly.com/earthEndText