"It's a definite wheeze," says Sandra Beck. "That's not a sound you make with a cold."

SHE KNOWS: Sandra Beck, a respiratory therapist who has asthma, treats asthma patient Aaron Caldwell, 6, at a children's clinic. (Mark Crosse / The Fresno Bee)

After 24 years as a respiratory therapist in Fresno – almost a dozen of them as an asthmatic herself – Beck knows what asthma sounds like. Air being forced through swollen and narrowed airways creates a distinctive squeak.

The high-pitched clattering she hears inside Brandy Jackson's chest is a textbook example.

"You can wheeze and not be an asthmatic," Beck says. "But it's the first reason that comes to our mind."

Brandy, 15, had no symptoms before this day in October – but two brothers are asthmatic. Having a family member with asthma increases your risk for the disease. What precipitated Brandy's airways to constrict and swell, Beck can't say. Something in the air, however, probably triggered her asthmatic response.

Beck suspects air quality in the San Joaquin Valley is the catalyst for her own asthma. She grew up in Vermont where the air was cleaner. She began showing signs of the lung disease after moving to Fresno in 1975, and was diagnosed as having it in the early 1990s.

"My asthma didn't get triggered until I moved to this area," she says.

Many of her asthmatic patients are sensitive to ozone, smoke and soot. She gets more patient calls on dirty-air days. Beck works for the Community Medical Centers Asthma Education and Management Program in Fresno, teaching people how to live with the lung disease.

Some of her patients leave Fresno because of their breathing problems. She doesn't discourage them; moving has crossed her mind. She takes trips to the Central Coast when she needs a reprieve from air pollution.

Foggy days that hold fireplace smoke close to the ground are the hardest on her lungs. "I don't go out much when it's foggy," she says. "I can feel my little bronchiole tubes twitching."

But dust blowing off plowed fields touched off one of her worst asthma attacks about a year ago.

"I thought if I took my inhaler [of asthma medicine] before I went to an outdoor concert that I would be OK," she says. "It was a bad choice to make."

Beck couldn't breathe and had to be driven home after 30 minutes standing outside to hear jazz guitarist Craig Chaquico at The Bastille in Hanford. She spent the next day in bed. Co-workers scolded her for exposing herself to dust in the air. "But I spent $70 on those tickets," she says.

Her experiences living with asthma make it easier to teach patients.

Beck pulls out a small laminated flip chart from her jacket pocket to show Brandy what airways look like when they are inflamed. The picture of a pink air tube doesn't appear to make an impression. Brandy barely nods.

She shows Brandy how to use an inhaler attached to a spacer, a plastic container about the size of a baby bottle. The spacer helps the medicine in the inhaler get into the lungs instead of on the tongue, explains Beck.

"I put mine [inhaler and spacer] together and shove it under my pillow so I can just pull it out at night," Beck says. "When I can't breathe, it wakes me up.

"I was over 40 when I had my first one [an asthma attack]," she tells Brandy.

An asthma attack "can be terrifying," Beck says. "The terror of, 'What if it happens again?' is very real."

Beck's first attack hit while she drove home from a respiratory-care conference in Napa. She was afraid she would have an accident before reaching the hospital. "I could feel [my lungs] getting tighter and tighter. I was gasp-breathing."

That first attack hit her by surprise. Today, Beck says she should have recognized the warning signs – a chronic cough and repeated bouts of pneumonia. She ignored them because she was in denial that she could have the disease.

She is sensitive to asthma clues now – like a dry, hacking cough.

Any time she hears the barklike sound, while shopping or at a social gathering, she investigates. "I will stop [people] right there to ask if they have asthma or if they have been checked for asthma."

She doesn't hesitate to tell asthmatic patients to stay inside on smoggy or foggy days or to tie a scarf around their nose and mouth if they do go outside.

"You have to warn them."

As for herself? She stays indoors.