WASHINGTON — Only one in five children with asthma has the disease under good control, sobering findings that are helping to fuel a shift in care.

The change: A stronger focus on day-to-day symptoms, not just the bad attacks, so that more of the 20.5 million Americans of all ages who have asthma can breathe easier without limiting their activities.

Federal guidelines due this summer are expected to urge doctors to more closely monitor whether treatment is truly controlling everyday symptoms and improving patients' quality of life — and to adjust therapy until it does.

Already, a campaign is under way to teach patients to recognize they need better help and how to convey that to a doctor. If the doctor's happy that you've had no flare-ups but doesn't know you had to quit playing soccer to do it, you're not achieving good control.

Too often, physicians don't realize how severe symptoms are, says Dr. Jill Halterman, a pediatric asthma specialist at the University of Rochester. With children, their own parents may underestimate symptoms.

It's more complicated than denial: When wheezing while running or waking up at night coughing has been routine for years, people may not know to complain.

"It may be part of what they view as normal," says Halterman, who is studying the control gap. "We're hoping we can change that so the goal can really be for the child to have no symptoms and no limitations on activities."

That's the goal for adults, too, as specialists shift from asthma's severity as the chief treatment guide to this broader goal of asthma control, adds Dr. Allan Luskin of the University of Wisconsin in Madison.

"They can live normal lives, but it takes work," says Luskin, who is working with the Asthma and Allergy Foundation of America's new patient campaign. "Patients and doctors need to understand that asthma can be controlled, and we really ought to expect nothing less."

Asthma is a chronic lung disease caused by inflammation inside airways that in turn makes them super-sensitive, narrowing in response to irritants that wouldn't bother a healthy lung. The result: recurring episodes of wheezing, coughing, chest tightness and difficulty breathing.