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 In the middle of the night, Casandra Cabrera stopped breathing. She doubled over in bed, gasping for air. In the panic that followed, her lungs constricted. Her eyes filled with tears. The asthma attack continued for 10 long minutes.

“I keep an inhaler with me everywhere. I have one in my purse, in my sports bag, and in my truck and by my bedside,” the San Joaquin Valley, Calif., teenager said. “I’ve never really imagined life without it. It’s kind of normal for me.”

It’s normal for many children, especially those in California, home to the country’s worst air pollution. More than 5 million people in the state have been diagnosed with asthma, which is caused, in part, by contamination from nitrogen compounds, pollutants that stem from the farming and transportation industries.

Climate change is expected to compound the issue, according to a new body of work published in the journal
Issues in Ecology. Higher temperatures and an increased risk of drought on the West Coast essentially “cook” the nitrogen, resulting in nitrous oxide and ozone. These nitrogen byproducts cause cardiovascular and respiratory diseases, especially among the region’s rural and urban poor who don’t have the money to move away and reduce their exposure.