Asthma statistics reveal a grim irony: The people who die from the disorder are usually those with the mild and moderate cases, rather than people with severe asthma.

In general, says Dr. Loren Greenway, the people who die are those who either don't realize how deadly their wheezing can be, or who ignore their doctor's advice.

"They don't think it's a big deal, and by the time they realize it, it's too late," says Greenway, director of pulmonary medicine at LDS Hospital. Greenway, along with Primary Children's Medical Center respiratory therapist Valerie Morgan-Wallace, will field calls about asthma Saturday during the Deseret Morning News Intermountain Healthcare Hotline, from 10 a.m. to noon. The toll-free number is 1-800-925-8177.

Asthma, a chronic inflammation of the airways, affects some 20 million Americans, including 1.5 million under the age of 5, according to statistics from the National Institutes of Health and the U.S. Department of Health and Human Services. Most of the time, Greenway says, asthma is "like a pot that's simmering. If it gets worse, it flares up, then it goes back to simmering."

Often people don't recognize that their wheezing, coughing, shortness of breath, or chest tightness adds up to asthma. In fact, even certified respiratory therapist Morgan-Wallace was thrown off guard when she found herself huffing and puffing during exercise after her son was born.

"I thought I was just out of shape," she says. It was the first time she'd ever had asthma symptoms, which were likely triggered by a shift in hormones following childbirth. Other triggers include pollen, pollution and cigarette smoke.

"Most people underestimate the severity of their breathing problems," she says. "We have children who come in and say they feel 'fine.' Then, after they're tested with a bronchodilator, they say they feel 'much better.' "

Some children, she says, may have had asthma their entire lives and may not have realized what it was like to breathe easily, before being treated.

An accurate diagnosis requires pulmonary-function testing, Greenway says. A first clue, though, can be provided during an acute attack: If inhaling a short-acting bronchodilator provides immediate relief, you've probably got asthma rather than something like bronchitis.

The bronchodilator works by relaxing the bands of smooth muscle that surround the airways, which become tight when there is inflammation. But this is only a quick fix. If you need to use the short-acting bronchodilator all the time, "you need to do something for the inflammation, because it causes everything else," Morgan-Wallace says.

"Controller" medicines include corticosteroids and anti-inflammatory agents that reduce swelling in the bronchial tubes. "People are afraid of the word 'steroid,' " Greenway says. But the side effects at the low dosage required to manage asthma "are really rare," he says.

On the other hand, a study published this past week in the journal Annals of Internal Medicine, reported that long-acting bronchodilators — known as long-acting beta-agonists — pose an increased risk of hospitalization and death compared with placebos.

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E-mail: jarvik@desnews.com