Little in the Nelson family’s life indicates that all four members have asthma. They keep dogs, go camping, and Cameron, 16, participates in a number of sports, from wrestling to cross-country.

Yet every night, Julie Nelson lays out medications for herself, Cameron, Conner, 9, and her husband, Jeff, that keep everyone in the Oaklandon family as healthy as possible.

“I don’t let asthma control my life,” said Julie Nelson, 42, who was diagnosed while in high school. “It’s just who I am. I’ve come to accept that.”

Nationwide, about 14 million people have asthma, about 9 million of whom are adults. In recent years, more children are being diagnosed. In Indiana, 9.2 percent of adults and 8.2 percent of children have the disease, according to state figures.

Most of these children will struggle with the disease throughout their lives. However, as their airways grow along with their bodies, they may not be as inclined to have attacks that are bad, said Debbie Koehl, chairwoman of the Asthma Alliance of Indianapolis, a group of local health-care professionals who aim to raise awareness about asthma.

“It’s considered a chronic disease,” said Koehl, pulmonary rehabilitation coordinator at Methodist Hospital. “I don’t think people ever truly grow out of it. What they grow out of is the severity of the disease.”

Patients such as Julie Nelson go to great pains to keep their asthma in check. Nelson cleans incessantly to minimize dust and runs the air conditioning to keep outside irritants out. She uses a peak flow meter daily to monitor her lung performance. If her levels drop, she increases the medicine she takes.

If all this sounds like a lot of work, consider this: Nelson and many other asthmatic adults find that handling their disease has improved immensely in the past decade, with the introduction of drugs that can not only stop attacks once they occur but also prevent them from happening in the first place.

“Our primary message is that it’s a controllable disease,” said Trisha Jenkinson Dane, asthma program director for the Indiana State Department of Health. “It’s not a sentence for a lifetime of misery.”

When Nelson was first diagnosed about 26 years ago, the only relief that doctors could offer was a rescue inhaler that they instructed her to take before exercise. Now, like most other asthmatics, Nelson uses a bronchodilator twice a day with a combination of medicines.

“This has simplified it and increases compliance in myself. If I don’t do it, I go back to using the rescue inhaler on a more continuous basis,” Nelson said.

The less likely an asthmatic person is to have an attack, the less likely he or she is to need emergency room care. Asthma care in the United States cost about $4.7 billion in hospital expenses in 2006, according to the American Lung Association.

That figure includes nearly 1.7 million emergency room visits. In Indiana alone in 2005, asthma accounted for more than 24,000 emergency room visits.

The best way to keep people out of the emergency rooms for their asthma, experts agree, is to educate them about what they can do to manage the disease.

“A lot of people don’t consider asthma a chronic disease, and it truly is and you have to treat it that way, the same way you would treat blood pressure or diabetes,” Koehl said.

Some people may not recognize asthma when they first develop it, especially if it presents as a chronic cough, said Lisa Flynn, a pediatric pulmonary educator at Peyton Manning Children’s Hospital. She recommends everyone be screened for the disease, just as they are checked for cardiac disease, diabetes and high blood pressure.

Doctors use a simple test, called spirometry to measure a person’s lung function. Some primary-care doctors have this test; others will refer their patients to specialists.

Once a person is diagnosed, medicines are the first line of defense. Doctors will take an escalator approach to prescribing the medicines, said Dr. Robert Reinhardt, an associate professor of family medicine at Michigan State University. They may start out at a low dose and keep increasing it until a person reaches control.

Drugs are not the only way to control asthma, experts agree.

“Medications are necessary but not sufficient,” said Reinhardt, also senior medical director for Phadia, a company that makes a test that looks for allergic triggers for asthma attacks.

The National Institute of Health guidelines for managing asthma recommend that patients who have persistent problems with asthma undergo such testing to see whether they have allergies that are at least in part responsible for attacks. The Phadia test, for instance, will check whether a person has allergies to common indoor allergens, such as pet dander, housemites, cockroaches and mold.

About 60 percent of adult asthmatics have allergic triggers. Identifying a person’s trigger can help him or her better manage their asthma, said Reinhardt.

If there’s no link, the patient does not have to expend time and effort trying to eradicate that potential allergen from the environment. If the tests show that a person does have an allergy, he or she can seek to avoid that trigger.

“There’s value in testing either way, whether you in fact identify triggers or you identify that they don’t have allergies or triggers,” Reinhardt said.

Too few clinicians do this testing, he said. About 80 percent of asthma patients see a non-specialist to manage this disease, and many do not realize this test is available.

Patients also need to pay attention to their own symptoms to gauge when they’re running into trouble, Flynn said. Diabetics have glucometers to measure their insulin; asthmatics have no comparable tool.

Instead, Flynn recommends that patients keep a symptom diary, tracking whether they are ever short of breath during the course of the day or night, whether they have a cough, whether they’re taking their medicine regularly or turning to the rescue inhaler.

Another indicator for how well people are handling asthma is whether they are living the life they would if they did not have the disease.

“The goal for good asthma care is you can do the things you want to do,” Koehl says.