Christina Edwards shot out of bed and motioned to her sister to call the paramedics.

She sucked on the nebulizer at her bedside more rapidly but to no avail — she still could not breathe.

In the ambulance to the hospital she remembers thinking this was the worst asthma attack she had experienced in her entire life.

“I could feel myself losing consciousness,” she said.

At 56 years old, Edwards has managed her adult on-set asthma quite well since her diagnosis in 1998. She was attack-free for two decades until that 1 a.m. wake-up call on April 18 inside her northwest Pasadena home, situated a few blocks from the 210 Freeway — one of the busiest in the region.

Edwards’ experience is not rare. Several million adults and children suffer from asthma in Southern California, home of the worst air pollution in the nation. The fact that the attacks are often triggered by breathing indoor air pollution is raising concerns and stirring up debate as to prevention techniques.

Indoor hot spots

As the evidence mounts correlating asthma and more serious lung diseases with polluted air, the number of asthma cases keeps on rising even with California’s progress in improving air quality.

“Asthma rates increased dramatically during the last three decades,” begins a 2016 report from the California Department of Health. “Every year about 40,000 Californians are hospitalized because of asthma…”

In Southern California, there were 21,452 more children and 20,360 more adults with asthma in 2018 as compared to 2017, the Lung Association of California reported. Southern Californians with chronic obstructive pulmonary disease (COPD), a condition that causes coughing, mucus production and wheezing, rose by 56,215 during the same time period.

One factor that stands out in study after study is proximity to freeways, rail yards, ports, warehouses and freight corridors known as local hot spots. And the hot spots extend to inside people’s homes, as well as in schools, daycare centers and other institutional facilities.

On-board vehicle emissions controls, cleaner fuel blends and reduced volatile organic compounds from paint, factories and electricity plants have contributed to dramatically cleaner air since the 1970s.

But even as outdoor air pollution levels improve and asthma rates slow, it “doesn’t mean there isn’t a serious concern for people living near pollution hot spots,” said Bonnie Holmes-Gen, senior director of air quality and climate change for the American Lung Association in California.

Homes, schools near roadways

Pollutants such as carbon monoxide and particulates can pool along roadways and neighborhoods crisscrossed by freeways, chemical plants and diesel railways, most often next to lower-income, urban neighborhoods. These pollutants flow into homes through doors, windows and cracks, often residences without air conditioning systems or filters, experts said.

Pollution from vehicles is connected to serious lung damage in children and adults living within 300-500 meters of major roads and freeways, said Holmes-Gen.

Those who live, work or attend school near freeways have an increased incidence and severity of health problems, such as asthma, cardiovascular disease, impaired lung development in children, low infant birth weight, childhood leukemia, cognitive deficiencies and premature death, according to a U.S. Environmental Protection Agency report entitled: “Near Roadway Air Pollution and Health” from August 2014.

Edwards, who lives two blocks from the 210, a freeway used more and more by trucks traveling between the Inland Empire and Northern California, saw her asthma attack progress into bronchitis and pneumonia, resulting in a six-day stay at Huntington Memorial Hospital.

The doctors pumped her body with steroids to restore her breathing. But now she is having heart issues, she said.

Through medication, her asthma was controlled for 20 years until the record heat and higher ozone levels of 2017, in part brought on by global climate change.

“With the fires and the heat we had, something was triggering my asthma like it has not done before,” Edwards said.

She’s under strict doctor’s orders to keep all her windows and doors closed and not to venture outside until after 8 p.m. She keeps an air purifier running in her bedroom at all times.

“I can’t take walks as far or when I used to,” Edwards said. “I have to wait until evening.”

Students and indoor air pollution

At Resurrection Elementary School in Boyle Heights, hallway signs remind everyone to close the doors behind them and not open the windows.

Due to the private Catholic school’s proximity to the 5, 60 and 10 freeways, the 230 children are exposed to polluted air while playing outside — and while sitting at their desks.

The South Coast Air Quality Management District has taken the extra step of installing air filtration systems inside each classroom. The systems are made by IQAir, a company based in La Mirada.

Since 2012, the AQMD has purchased commercial air filtering devices that have been installed in 72 schools and related institutions from Coachella in Riverside County to the L.A. port cities to East Los Angeles at a cost of $13 million.

The somewhat under-the-radar program has a single objective: to protect children from lung damage while breathing inside buildings. Until diesel trucks and locomotives are scrapped for electric-powered ones, the SCAQMD is using money set aside by polluters to expand its air filtration program.

“While we are focused on doing all we can to clean up our transportation fleet, we are also taking advantage of opportunities to prevent and reduce localized exposure to vehicle emissions, such as school air filtration projects,” said Wayne Nastri, SCAQMD executive officer in a prepared statement.

Resurrection teachers are trained by SCAQMD that the air filtration machines work better when all doors and windows are kept closed, said Tiffany Allegretti, a spokesman for IQAir. Brochures are sent home with students carrying the same message to parents.

About the size of a small refrigerator, the boxes are affixed to classroom walls, silently filtering out 90 percent of particulates, said Matt Miyasato, deputy executive officer of science and technology at SCAQMD.

“The concern is about ultra fine particulates and black carbon that can get into the lining of the lungs,” he said.

The development of a child’s lungs makes them more susceptible to irritants from the environment, said Ed Avol, a researcher on air pollution and children at USC’s Keck School of Medicine.

Ultra fine particles are so small there can be tens of thousands in a single cubic centimeter. When they reach the bloodstream, they can damage the respiratory system but also the brain, affecting learning, development and behavior.

Studies have found children from low-income areas near freeways will grow smaller lungs, decreasing capacity and possibly leading to asthma and COPD as adults. Research conducted by Rob McConnell, a professor of preventative medicine at Keck School, indicates that at least 8 percent of the more than 300,000 cases of childhood asthma in Los Angeles County can be attributed to traffic-related pollution at homes within 75 meters — a little less than 250 feet — of a busy roadway.

This spring, SCAQMD is spending $250,000 to upgrade the units and replace filters that have become blackened with carbon and diesel exhaust particles.

“We know these filters are needed,” said Resurrection principal Rocio Flores. “We are in a highly polluted area of Los Angeles. This will definitely improve the air our students will have access to and it will help our kids learn better.”

“It helps them to stay healthy, especially with all the pollution around here,” said Naira Bucio, who has a child in fourth grade at Resurrection. Her children do not have asthma, she said.

And for only the second time, SCAQMD is installing air filtration systems at a daycare – the center at Plaza Community Services in East Los Angeles.

Directror Ted Gottis believes it will improve the indoor air quality for the 65 children that attend daily. But like many interviewed for this report, he questioned whether the devices are the solution to the problem of indoor air pollution and disagreed with the city of Los Angeles’ decision to allow more housing to be built next to freeways.

“I think we are made to ignore it. It is a purposeful deception,” Gottis said.

Getting to the source

While filtering the inside air has its benefits, Avol wonders how effective it is. Once the window and doors are open, that hampers effectiveness, he said.

Also, a child living in hot spot zones only spends a few hours inside a classroom every day as compared to time spent outdoors where the air is not filtered.

“It should help them learn better, pay attention better and be healthier for that period. Then they go out and run around in a playground and they are breathing five to 10 times the rate at which they were sitting in class,” Avol said.

Air filtration inside a school or daycare may make a parent feel their child is safe when he or she is not, he warned.

“The concern I have is that it takes people away from the notion that we have to keep fighting to clean up the air. I don’t think we want…a society wearing masks or using filtration inside,” Avol said.

“Having the system is better than nothing. But the problem isn’t that we should be filtering children’s (indoor) air so that the air pollution doesn’t kill them for having the audacity to breathe,” said Angela Johnson Meszaros, staff attorney at Earthjustice in Los Angeles.

“What we ought to be doing is looking at systemic change.”

Meszaros criticized the SCAQMD for not doing enough regarding pollution from refineries, trucks and warehouses, while acknowledging cracking down on diesel trucks is the primary responsibility of the California Air Resources Board and the EPA. Last week, the air district voted to look into ways of reducing air pollution from roads, freeways and warehouses served by diesel trucks.

“We’ve known this for decades and it is only getting worse. Those communities are particularly burdened,” she said. “It is a half step. It is a half measure.”

Holmes-Gen agreed that the only way to reduce pollution inside homes and schools surrounded by trucks and cars is to transition away from fossil fuels. She supports Gov. Jerry Brown’s goal of 5 million electric cars on the road by 2030. She called the air filtration devices a mitigation measure, not a solution.

“Freight pollution and traffic pollution is causing unacceptable lung damage in children, especially in L.A. and other urban areas that have the highest concentration,” she said. “The levels of pollution there are unacceptable.”