Sacramento (CBS13) – Asthma hits school-aged kids at higher rates than other age groups, according to the California Department of Public Health. It is especially hard to breathe for students in the San Joaquin Valley, and administrators are asking parents to take action before it’s too late.

READ MORE: Yuba County Water Agency Could Ship Billions Of Gallons Of Water To Bay Area Amid Drought

Fifth grader, Karyna Rios uses a machine called a nebulizer to take medication for ten minutes, four times a day.

“It like releases the pain on my lungs,” said Karyna.

Add that nebulizer to her inhaler and other medications she takes on a daily basis. The 11-year old has been managing severe asthma since she was a toddler.

“She doesn’t get a good night’s sleep because of her asthma, ’cause she’s choking and can’t breathe because of the mucous,” said Karyna’s mother, Maria.

And at Karyna’s school, Bret Harte Elementary in Modesto, recess can be a problem.

“Sometimes when you’re running, your chest gets hard and then you can’t breathe,” said Karyna.

Living in the San Joaquin Valley poses an equally big problem.

“We seem to be built to retain air pollution. We’re almost completely surrounded by mountains, we don’t get a lot of windy storms,” said Anthony Presto of the San Joaquin Valley Air District.

The area is second only to Los Angeles when it comes to worst air quality in the country, adding extra aggravation to people with asthma.

“Our cleanest time of year tends to be in the spring when we do have more rain and wind,” said Presto.

In the summer, there is smog baking in the sun, creating ozone pollution. Then in the fall, it is the dust from harvest season. Fine particulate matter fills the winter air from wood burning fireplaces. That’s Karyna’s toughest season.

“I’m always worried about her, always,” said Maria.

READ MORE: Rio Linda Sandwich Shop Owner Recovering From Stabbing

But she’s confident they have Karina’s asthma under control. That’s not always the case for other kids, according Bret Harte school nurse, Diana Connacher.

“I think there’s a lot of students and adults that aren’t clinically diagnosed with asthma,” said Connacher.

Out of 940 students, she has 72 diagnosed with asthma. But she believes that number could double, saying socioeconomic issues and lack of information may be keeping kids from getting diagnosed.

“There’s actually been people that die from lack of treatment,” said Connacher.

Numbers from the California Department of Public Health show how asthma rates rise as you go south into the San Joaquin Valley.

Of school-aged kids, 12.7 percent are afflicted with asthma in Sacramento County. That number jumps to 14.6 percent in San Joaquin County, 20.8 percent in Stanislaus County, and 23.1 percent in Merced county.

Connacher says parents need to watch for symptoms, especially when kids get sick.

“They’re wheezing, you can just hear it. You don’t need a stethoscope to hear it,” said Connacher.

Modesto schools team up with the San Joaquin Valley Air District to fly air quality flags every day and ask parents to shut off their engines at pick up and drop off times. That keeps kids from breathing in exhaust.

“It really makes a big difference,” said Presto.

A lesson Karyna and Maria hope goes a long way to keep kids healthy.

“They need to pay a little bit more attention to their children,” said Maria.

MORE NEWS: Sacramento Animal Care Services Pushes For More Help For Homeless Pets

It’s not all bad news. Air quality in the San Joaquin Valley is actually getting better. Presto says 2013 was the first year the valley had no violations of a key ozone pollution standard. It means efforts in the valley to cut down on smog have paid off. Now the air district is asking the EPA to drop a $29 million annual penalty residents have been paying mostly through DMV fees.