A day doesn't go by that Butler resident Sarah Bono doesn't have to alter her life to avoid a respiratory emergency.

Bono, 18, is among the nearly 10 percent of Americans — and one in every 13 children — that have asthma, a breathing disorder provoked by common allergens like pollen or by exercise. It results in excessive mucus production and throat swelling that can block airways.

While a combination of medications allows many asthmatics to perform daily tasks without much interference, others must change their lives to avoid asthma triggers.

Bono was diagnosed with the chronic respiratory disease when she was 2. It has gotten increasingly worse in the past two years, which she said is typical with females.

"It's to the point where I'm not sleeping at night and I'm using five inhalers — three daily and two as needed," Bono said.

Up to every three hours daily she also uses a nebulizer, a machine that uses compressed air to deliver asthma medication to open up air passages. Nebulizers are typically reserved for hospital use, but they are also given to asthma patients who have frequent respiratory emergencies.

Many people, including Bono, see dramatic shifts in the severity of their symptoms throughout the summer months.

Pollen counts usually rise with the temperatures in spring and early summer, causing increased doctor visits, said Bono's physician, Dr.David Skoner, a pediatric allergist and immunologist at Allegheny General Hospital.

However, many get relief from their symptoms between mid-July and mid-August.

"Ragweed pollen peaks around Labor Day," Skoner said. "The pollens are still a problem right now, but they should be clearing out by mid-July."

Bono looks forward to the temporary relief, but she has learned to expect extreme symptoms in the fall and winter.

Skoner said asthma sufferers should never stop taking their medications, no matter how good they feel during symptom breaks.

If medicines are not taken daily, more severe symptoms can occur when pollen counts rise again, which causes emergency hospital visits to skyrocket in September.

Skoner also advises asthmatics to pay close attention to avoiding their triggers.

The most common asthma triggers are pollens, molds, furry animals, dust mites, stinging insects and many food proteins, according to the American Academy of Allergy Asthma and Immunology.

"If a patient is having a hard time," Skoner said, "it usually signals to us that they need to get better control."

For better control, he implements an action plan, which includes periodic medication increases and decreases, an exercise regimen and home environment modifications.

For some people, however, the plan is not always effective.

Bono's condition, aggravated mostly by dust mites and tree pollens, got so severe that she was homebound for the last month of her senior year of high school, forcing her to be homeschooled.

She is also attending community college in the fall, because she fears being too far away from her home and doctor.

"I like to be active," she said, "but I can't go out and take walks or do things because I'm afraid of not being around my medicine."

Although Skoner said Bono's condition is not typical, severe asthma does affect a lot of people, especially when exercising.

A.J. Racioppi, 20, of Cranberry Township has had severe asthma triggered by exercise and many allergies all of his life, but he is able to go away to college and participate in most daily activities.

"I think if an average person without asthma suddenly had to endure mine, they would be overwhelmed," he said. "To me, it's just something Ihave had to live with and I guess I am kind of used to it. It is still a burden, though."

Racioppi takes medications to lessen his symptoms. He also carries a rescue inhaler and has a nebulizer at home for emergencies.

Still, he finds it difficult to be as active as he would like.

"Iknow that if Iwant to play a sport with friends, Iabsolutely have to have an inhaler on me because Iwill have an asthma attack," he said.

"I am a huge hockey fan and would love to play ice hockey, but it is totally unrealistic for me."

While strenuous exercise often provokes asthma attacks, Skoner urges people not to completely avoid exercise.

Instead, he suggests working with a physician to gain better control of exercise-induced asthma flare-ups. This includes learning your limits by gradually increasing exercise intensity.

Although severe asthmatics like Bono and Racioppi will likely deal with the condition for life, many see relief as they age. About half of asthma sufferers under 20 won't have asthma as adults, Skoner said.

"It depends on the person's severity level," he said. "If severity is high, it usually won't go away. But, it depends on the individual."

Also, about a third of those who see symptom relief in their 20s will relapse later in life, he said.

Although people can develop asthma at any age, it is most commonly diagnosed in children between 3 and 5, according to the American Respiratory Alliance of Western Pennsylvania.

Wheezing, a common symptom for asthmatics, can be one of the first indicators of the condition, which can begin as early as infancy.

Wheezing may subside for many infants, but if it becomes a persistent or recurring medical attention should be sought, especially from an allergist or immunologist.

The National Lung, Heart, and Blood Institute lists the following five symptoms as being most commonly associated with asthma:• Coughing that generally worsens at night and in the early morning, making sleeping difficult.• Wheezing that sounds like a whistle or squeak when breathing in, out or both.• Chest tightness that may feel as though someone is sitting on your chest.• Shortness of breath or struggle getting air in and out of your lungs.• Rapid breathing that occurs as a result of breathlessness.