Asthma portrayals on screens are problematic. It’s time for change.

What do you see when you think of a character with asthma on screen? Is it a young nerdy boy who can barely go a minute without wheezing or puffing on his inhaler? Film and television have, for decades, cemented that trope. From Mikey Walsh in The Goonies to Stevie in Malcolm in the Middle, not to mention the animated characters of Milhouse in The Simpsons and Carl Wheezer in Jimmy Neutron: Boy Genius – having asthma is rarely portrayed as a symbol of cool, rather a pejorative marker of weakness. 

2023’s May December, written by a screenwriter with asthma, is changing this trite representation of the condition.

The NHS defines asthma as “a common lung condition that causes occasional breathing difficulties.” People of all ages can have it. It often starts in childhood but it can also develop for the first time in adults, especially since the pandemic. While there is yet to be a cure, “simple treatments can help keep the symptoms under control so it does not have a big impact on your life.” Yet asthma is frequently played up or down in screen depictions, with many writers and performers showing a clear misunderstanding of what it means to live with the condition. From ill-defined asthma triggers and characters not using their inhalers correctly, to the illness used as a life-threatening plot device or presented as something that can be overcome with the right attitude, there’s a real-world effect on how people with asthma deal with their illness or not. 

Natalie Portman and Julianne Moore thrill and chill in “May December.”
Credit: Francois Duhamel / Netflix

“Depictions of asthma being not being particularly cool have a genuine impact on how people manage this condition,” Naomi Bennett-Steele, innovation partnerships manager at charity Asthma + Lung UK tells Mashable. She points to films like the recent Ghosted, in which Chris Evans’ character Cole’s asthma is briefly used as an excuse for him to stalk Ana De Armas’ love interest Sadie via a tracker tile he had stuck on a missing inhaler. “I’m sorry, you did the ‘leave behind’ with the inhaler,” Cole’s sister scoffs. “Come on, isn’t your asthma sad enough already?” 

According to a recent Asthma + Lung UK annual lung health survey, 45 percent of asthma respondents think there is a stigma attached to living with asthma and 60 percent of those who think there is a stigma attached say they have faced stigma or discrimination due to their asthma. “These kinds of social influences can steer people towards not taking their inhaler in public or they don’t want to accept that they’ve got an asthma diagnosis,” says Bennett-Steele.

Normalising the asthma experience

As an asthma sufferer since birth, I am extremely cognisant of both the continued stigma as well as the long-running media representations that have perpetuated it. Like Bennett-Steele, I believe that more normalised portrayals can help to ameliorate the image of asthma in the public consciousness. Screenwriter Samy Burch’s depiction in this year’s award season contender May December is a step in the right direction. Mashable spoke with Burch about her own experience with asthma and how that impacted her writing process.

As an asthma sufferer since birth, I am extremely cognisant of both the continued stigma as well as the long-running media representations that have perpetuated it.

In Todd Hayne’s true crime-inspired melodrama, written by first-time screenwriter Burch, Natalie Portman’s Hollywood actress Elizabeth arrives in Savannah, Georgia, to shadow the subject of her next film: Julianne Moore’s Gracie, a 59-year-old woman who notoriously had began a 23-year-long relationship with her now-husband Joe (Charles Melton) when he was just 13 years old. While most of the film is loosely based on the real-life case of Mary Kay Letourneau, Elizabeth’s asthma is based on Burch’s lived experience; she’s a third-generation asthma sufferer whose diagnosis, she says, is “inherent in the way I go through the world.”

Burch is very aware of the sickly, neurotic stereotype that often defines characters with asthma. While she does have a soft spot for David Krumholtz’s Joel Glicker in Addams Family Values, Elizabeth is very much an outlier. A beautiful woman with a coveted, glamorous job, the actress’s asthma experience is refreshingly mundane. In one scene, Portman casually uses her inhaler while talking on the phone and checking out Gracie’s profile on the sex offender register. She’s not on the brink of death, just taking her medication like any other asthma sufferer. “With this character, I didn’t want it to feel like a metaphor for something,” says Burch. “Because of my experience, there’s a certain amount of truthfulness.” 

That includes the environmental triggers that might not all be explicit but are fundamentally based in fact. So often, stress is the main trigger for an asthma response in a character. A 2012 study found it was the most common scenario (41.5 percent) when examining 66 films from the 1980s to 2007. “That image of someone taking their inhaler because they’re feeling a bit nervous? There’s so many different things that can trigger people but all the representation that we get is stress or sometimes exercise,” notes Bennett-Steele, adding that this in turn can prevent people from being given a formal asthma diagnosis. “The number of people who are who initially told. ‘oh, it’s just anxiety.’ That’s denying people the care that they need because there’s a misunderstanding of this condition, which is fueled by the kind of tropes that sit around it. Anxiety can be a huge trigger for asthma, but that’s not all that it is.”

Burch chose to reflect on her own experiences from visits to Southern cities, for example, where the pollen in the air and the heat have affected her ability to breathe. “Something about the air – it’s spring and it takes place at graduation time – and Elizabeth’s probably in a historic inn, these are all traditional triggers for breathing,” she explains. “So I folded those little moments in there so it didn’t feel completely out of the blue, like seeing her using her inhaler a few times and her nebulizer at one point at night in the inn.”

When it comes to asthma sufferers, “climate change and heat is a huge thing,” notes Bennett-Steele as does Harvard’s School of Public Health. “Particularly people who are living in cities where it gets significantly hotter. You can have this strange thing where there’s a thunderstorm in summer and it zaps the pollen, making it tiny, so people inhale more of it.”

The most common triggers for asthma symptoms are colds and viruses, pollution, pet hair, dust mites, physical exertion and cigarette smoke, the latter of which Burch uses to set up a rather droll seduction involving Elizabeth’s nebulizer. The breathing tool delivers high doses of medicine in a fine mist to clear a person’s airways when inhaled through a face mask or mouthpiece. When the screenwriter needed a nebuliser in real life, she felt amused by the visual smoke mist connection to a dame in a classic crime drama. “There is something so Noir about the way this smoke is falling out of my mouth, you know what I mean?” Burch says. “Like a cigarette, but then it’s so medical; there was something very funny to me about that.” 

When Elizabeth discovers Joe used to help his sister with her asthma as a kid, she pretends she needs his help to fix her nebulizer, to entice him to come back to her place for a sexual rendezvous. “It’s as thinly veiled as, ‘Oh, do you want a coffee? Can you change my light bulb?” Burch describes the seduction tactic. “I liked this dynamic of Joe being a caretaker – he has this history, they have this bond because they both have this history, it sort of links them in this weird way over this common childhood affliction – but obviously, adults have it too.” 

Using asthma to bed a guy is a pretty original plot device and certainly a tonic compared to the highly dramatic pitfalls the chronic illness is usually associated with. Burch recalls watching a Baywatch rerun with a “very disturbing asthma storyline” involving a child experiencing an attack without their inhaler. “One of the lifeguards takes a water bottle, a cotton T-shirt and a little fan to make a filter for the kid that’s having an asthma attack,” she recalls. “I’ve always had that in my head as the worst-case scenario – I don’t know if that’s real.”

Baywatch isn’t alone in using the absence of an inhaler for dramatic purposes. In World War Z, Gerry (Brad Pitt) has to make a pitstop in Jersey, while escaping a zombie apocalypse, to loot some inhalers from a pharmacy to help his daughter from an asthma attack. More recently in Scream (2022), Jenna Ortega’s Tara realises she left her inhaler at Woodsboro Hospital. Instead of buying a new one from a pharmacy, so they can get away from the murder spree, she, her sister Sam, and Sam’s boyfriend Richie put themselves back in danger by heading back to town, to her friend’s house to get her spare. It’s thanks to Ortega that there’s any continued asthma representation in the 2023 sequel as revealed in the DVD commentary: “When Jenna first read the script she was like ‘Where’s my asthma?’” She had wanted to keep that alive and a part of Tara’s journey.”

“I didn’t want this to feel like there’s any danger or it’s being used as a plot device in a way that’s exploiting chronic illness because, for most of us, it’s very every day.”

There was enough melodrama in May December without going over the top with the asthmatic element. “I didn’t want this to feel like there’s any danger or it’s being used as a plot device in a way that’s exploiting chronic illness because, for most of us, it’s very every day,” she says. “There’s a comfortability, especially if you grow up with it.”

While some people do live with extreme cases of asthma, it is a completely manageable illness for many more. Yet Benett-Steele says that, shockingly, the UK has one of the worst asthma death rates in Western Europe, and at least half of those deaths belong to people whose asthma is not particularly severe,” she says. “People who shouldn’t have died essentially.”

Combatting harmful stereotypes

Media misconceptions feed into the notion that asthma is a childhood illness you grow out of. In World War Z, another father at the pharmacy suggests it to Brad Pitt’s Gerry after handing him some albuterol inhalers. In V for Vendetta, Portman plays Evey, a character who says she used to have asthma as a kid. She mentions the chronic illness when she’s struggling to breathe after discovering her torturous imprisonment was at the hands of antihero V. The suggestion is that she stopped having asthma decades ago but she’s suddenly re-experiencing the symptoms because of the overwhelming stress and overcomes it with sheer willpower.

Perpetuating the psychosomatic misconception

Several films perpetuate this psychosomatic misconception of asthma, presenting it as a neurotic disease that can be cured by strength of mind. In Hitch, the socially awkward Albert (Kevin James) uses his inhaler whenever he feels nervous, however, he only musters up the courage to kiss his gorgeous love interest after dramatically throwing his medicine away. In The Goonies and It – Chapter One, the asthma diagnosis of Mikey and Eddie, respectively, is tied to overbearing mothers. Hungarian-American psychoanalyst and physician Franz Alexander described asthma as an “unconscious suppressed impulse to cry for the mother’s help.” Mikey’s mother tries to prevent him from leaving the house: “If he’s coming down with asthma, I don’t want him out in the rain.” That phrasing shows a complete misunderstanding of how the illness functions. He takes his inhaler around 11 times and throws it away at the end after pulling off a heroic adventure with his friends. Eddie uses his inhaler whenever he’s afraid but it turns out his asthma isn’t real, just a psychosomatic response to his overprotective mother. His rejection of his mother and the illness is once again seen as a show of strength and perpetuates a concerning image of asthma as a polarising condition that is either extremely debilitating or simply psychological.

One of the better, more recent representations of asthma in a young boy is in the 2021 film Ron’s Gone Wrong. Barney is a bit of a loner from a low-income household who manages his asthma throughout but experiences an asthma attack in a climactic finale and relies on the malfunctioning robot Ron to save him. Barney downplays the severity of his asthmatic event, he doesn’t want to be a burden, and when his classmates rush to meet him they don’t mock him for his weakness. It’s also medical treatment that helps him overcome the attack – not a change in attitude. He gets to be heroic and still has asthma at the end. The filmmakers take his condition seriously and highlight how common it is for socially disadvantaged people to be diagnosed with asthma. 

“The reality is asthma affects more people who are disadvantaged on multiple levels,” says Bennett-Steele. “It affects people who have cold, damp or mouldy houses and kids who have had to grow up in areas with high air pollution. It affects the poorest people in this country more than it affects the richest people in this country.”

It can also have an adverse effect in countries where health infrastructures are not accessible. In Arab and Tarzan Nasser’s Gaza-set drama Dégradé, a woman experiences breathing difficulties while trapped in a hot beauty salon, along with several other women, as gunfire breaks outside. She has an inhaler but a brief discussion about the struggle to get effective treatment for her respiratory problems highlights one of the many social health issues faced by Palestinians living under Occupation.

There are myriad ways that asthma sufferers live with and manage their illness. While efforts from filmmakers like Burch go a long way to normalise the experience, more can be done to effectively portray asthma without the stigma or inaccuracies but as part of the daily routine of living. “Most people experience maybe a handful of asthma attacks, if any, so if films showed someone waking up, having breakfast, and taking two puffs of their inhaler before brushing their teeth, how normalizing would that be?” Bennett-Steele suggests. “It’s a really small change that can potentially save lives.”