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Amid reports that more Utahns are wheezing and hacking from asthma, and new efforts to counter its curse, there's an elephant in the air that seems to get little attention: reducing the sickening haze.

Summertime ozone and wintertime inversions send more adults and children to the emergency room with respiratory problems, according to state and national data.

Utah's new asthma action plan — released Wednesday to help prevent and control symptoms such as breathlessness, coughing, wheezing and chest tightness — emphasizes limiting exposure to pollution. It doesn't mention reducing pollution.

The omission isn't because health officials don't recognize the problem, they say. It's because improving air quality isn't the Utah Health Department's job. That's up to the state Department of Environmental Quality.

And it may also be a recognition of the enormity of the problem.

"Everyone agrees we have to improve our air quality," said Michelle Hofmann, medical director of Riverton Hospital's Children's Unit and a clean-air advocate who helped write the asthma plan, along with public health, school, hospital and health insurance officials.

"I've been working on this issue [improving air quality] for almost seven years now, and I've shifted my own focus to health protection and promotion, recognizing this is a huge beast and it's going to be very difficult to make significant improvement in our air quality."

Reducing triggers for asthma attacks — from pollution to tobacco smoke to pet dander — is critical, according to another report released Wednesday.

The "Asthma in Utah Burden Report 2012" shows 9 percent of adults and 7 percent of children, or 240,000 Utahns, have asthma. Asthma among adults has grown almost 29 percent in nine years.

Asthma rates are rising nationally, too, and it's unclear why.

Obesity may be a factor and it is known to make symptoms worse, according to the report. Almost 12 percent of Utah adults who are obese have asthma, higher than the 7 percent of normal-weight adults with the disease.

Also, more people may be aware of asthma and seek a diagnosis, said Kellie Baxter, spokeswoman for the Health Department's asthma program.

Exposure to tobacco smoke is a known trigger of attacks, and more Utahns who have asthma are smokers or allow smoking in their home, compared to adults who don't have asthma.

The economic toll is high: $16.2 million in asthma-related hospitalizations in 2010.

About 20 Utahns a day seek medical help with boys, ages 1 to 4, leading in emergency visits and hospitalizations.

Asthma hospitalization rates for adults in Daggett, Duchesne and Uintah counties are double the state's rate. They live among oil and gas fields in the eastern Utah's Uinta Basin, where ozone levels exceed federal Clean Air Act standards in the winter.

"We've seen some significant air pollution problems ... in the Uinta Basin. It sounds like this may be one of the symptoms of that problem," said Jeremy Nichols, with WildEarth Guardians, who sued to get the Environmental Protection Agency to declare that the basin's air violates standards. While the EPA acknowledges the problem, it has declined to regulate the pollution.

"Once they make the declaration, then it has to get cleaned up," Nichols said. "You can't solve a problem until you admit there is one."

Jeramie Tubbs, spokeswoman for the Tri-County Health Department, said it's unclear if the ozone problem contributes to hospitalizations, though "you can't rule it out."

Last winter there was no ozone problem because there was so little snow, she said. But there isn't data yet on last year's hospitalization rates to see if it was lower.

Hofmann agrees it's hard to say whether air quality is a worse trigger than others. Doctors, she said, are good at asking about tobacco exposure and pets, but not air quality.

"We know the air is affecting them. I see it," she said, recalling being struck last week at the number of toddlers hospitalized for breathing problems. "They didn't have the typical cold symptoms, and they turned around very quickly once removed from outdoor air."

She said Utah's action plan emphasizes helping asthmatics track their symptoms during ozone season, May to September, so they can adjust their outdoor activities. Federal standards may be higher than what actually causes problems for people, Hofmann said.

The plan also calls for schools to reduce pesticide use, patients to get flu vaccines and to increase the number of smoke-free rental units.

Baxter said the Health Department supports Gov. Gary Herbert's Utah Clean Air Partnership for businesses and individuals to voluntarily take steps to improve the air.

She added the school work group may add more anti-idling policies on school grounds. "We are aware of and working on these issues."