Fuerte, 49, describes himself as an "environmental asthmatic." Breathing on a smoggy day in the central San Joaquin Valley, he says, is like "driving with a hand brake up."

FIGHTING FOR AIR: Fred Fuerte, 49, has severe asthma and is confined to his house in Fresno for much of the day. Fuerte says breathing on a smoggy day in the Valley is like "driving with a hand brake up." (Mark Crosse / The Fresno Bee)

Twenty-six times last year, he needed medical help to breathe and had to go to an emergency room in Fresno.

He keeps a syringe loaded with medicine to stop asthma attacks on his kitchen counter, a bag packed at his bedside to take to the emergency room and a canister of oxygen in the corner.

In June 2001, he had to be airlifted from an asthma camp in Yosemite National Park, where he was a volunteer coordinator.

A month later, he spent 12 days in the hospital when his lungs clamped shut.

This July, Fuerte says a string of smoggy days triggered an asthma attack that he couldn't control with the medications he keeps at home.

He called an ambulance after three days of labored breathing.

"Before I called the ambulance, I put myself on oxygen," he says. For this asthma attack, he stayed a week in the hospital.

FIGHTING FOR AIR: Fred Fuerte's nightstand is filled with medications and inhalers. (Mark Crosse / The Fresno Bee)

Fuerte moved to the Valley 18 years ago from his native Hawaii. He was a petroleum engineer before he went on disability at 32. Now he volunteers with the American Lung Association in Fresno to teach asthmatics how to live with their disease.

People ask him why he left Hawaii – or why he doesn't return. He moved to the Valley to be close to his children.

"But it's not easy to breathe in Fresno," he says. This summer, for eight days in August, he was afraid to go outside because of the smog.

Says Fuerte: "It's just like being in prison."