Research for a movie script

HI,

I'm an independent scriptwriter researching for a movie where the hero’s seven year old daughter suffers with SEVERE asthma. I wondered if someone would be kind enough to help and ensure things are true to life and factual.

So,

If a seven year old girl had a severe form of asthma would (or could) she be housebound? For example, if it's possible she might have a severe attack at any time would she still go to school? I'd like her to be housebound if that's factual.

Could she sleep in an oxygen tent?

If so, would / could there be some kind of Ventolin mixture that is also pumped in?

What other equipment would she have around the house – just in case an attack happened? Doesn’t have to be everything, just a flavour for the viewer.

Are there any daily tests she’d need to do. I understand there's a home test to determine oxygen levels in the blood. Would she do this and why? Also, how would this work???

Would (could) she use any of these things and if so when / how -- Pulse Oximeter, Nebulizer, ET tube

Could she have any pets or would they stimulate an attack. If so, what could she keep as a pet?

Is there a monitor that she could be hooked up to that lets off an alarm if she stops breathing at night? If so, how would this work?

If during a later scene she suffers a severe attack in her sleep, would / could she fall unconscious? Would / could she stop breathing? And what would the mother then need to do to save her life?

Appreciate there’s a lot of questions here and hoping someone can help.

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People are housebound by asthma. I would expect it to be possible to take her out in a wheelchair - and it is fairly unusual to be so restricted by asthma - i know people who can rarely get out due to asthma, and cant walk around much due to asthma. I can imagine school not being an option in a severely asthmatic child as schools are ofen poorly equiped to deal with brittle asthma!

Sleeping in an oxygen tent would be a bit weird as far as i know - never heard of it. In some people asthma can cause irreversible damage which may lead to the need for continuous use of oxygen (most likely through nasal canulae. I also know of asthmatics who sleep using a BiPAP machine which may suit your needs, this is pretty rare, but i know it can happen!

ventolin wouldnt be pumped in continuously, although it is more than possible for her to be using salbutamol (the drug name of ventolin, like vaccum cleaner/hoover) nebulisers four times a day (plus more if needed)

Nebuliser machines could easily be around the house, if she was using continuous oxygen she would likely have a concentrator. She might have a port-a-cath fitted to save on cannulas, and i know people who have these who use home IV anti-biotics (but this would rarely be continuous, more in the case of infection), she might have a pulse oximeter to measure the o2 in blood and heart rate which might be helpful to determine if she needs to go into hospital. To do this you just put it on her finger and itll give two numbers (for your reference oxygen is usually expected to be over 94%, and heart rate in a child id expect to be not much above 100, but salbutamol increases heart rate - i can happily get up to 150 hr, plus if on continuous o2, she might have slightly lower levels of o2 to prevent her co2 getting too high - BiPAP might help lower co2 levels). she would have peak flow meters, spacers, and inhalers, as well as steroids and other tablets. Some asthmatics have severe allergies so may have epi-pens. some asthmatics become adrenal insufficient so may have emergency injections of hydrocortisone (google adrenal crisis)

Peak flow is a common test for asthma, you can work out her expected PF using height and age on the internet easily, and generally a PF below 50% is a sign of a bad attack, below 33% is a life threatening attack.

As long as she wasnt allergic to the specific animal she could have a pet, although some viewers probably wouldnt believe that - it might be easier to have some kind of reptile, but I have cats as im not allergic to them, but can't cope well with dogs!

Im really unsure about this but i believe some BiPAP machines will set off an alarm if the user stops breathing - you'd have to check that. most of them alarm if the machine is not fitted properly, and i think some rely on the user to initiate a breath and it then assists the breath, so i ould have thiought if no resp effor was made then it would alarm??

If she stopped breathing it is unlikely that the mother could do much. certainly in a severe attack you would ring 999, put her on nebulised salbutamol (and possibly ipatropium)- these can be done through BiPAP machines if she's not breathing much. she could certainly lose consciousness. If it was an allergic response or whatever she might respond to an epi-pen.

As far as i know this is all right - you are certainly looking at by far the most extreme end of asthma so its worse than mine, so im less sure! whats the film about??

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Many thanks for your response. Some really useful information and much appreciated. Would you mind if I contacted you again should I need any more information?

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I'm an independent scriptwriter researching for a movie where the hero’s seven year old daughter suffers with SEVERE asthma.

If a seven year old girl had a severe form of asthma would (or could) she be housebound? For example, if it's possible she might have a severe attack at any time would she still go to school? I'd like her to be housebound if that's factual.

that would depend on the school, and her individual support plan. I have been housebound by my asthma, BUT only because my husband hasn't been here to push my wheelchair. I would think it would be more normal for her to be at home if experiencing an exacerbation, but otherwise at school.

Could she sleep in an oxygen tent?

- if people need oxygen, they would have an oxygen concentrator and nasal specs (tube which sits under the nose), not a tent. It would be very unlikely that someone with asthma would need permanent oxygen, thats usually because of other lung diseases. Oxygen is used in asthma when having an exacerbation of symptoms only if oxygen saturation drops.

If so, would / could there be some kind of Ventolin mixture that is also pumped in? - no oxygen tent.

What other equipment would she have around the house – just in case an attack happened? Doesn’t have to be everything, just a flavour for the viewer.

probably a nebuliser if she has severe asthma, though many people don't have nebulisers at home as its not generally advised - it can delay treatment at hospital and increase risk

Are there any daily tests she’d need to do. I understand there's a home test to determine oxygen levels in the blood. Would she do this and why? Also, how would this work???

peak flow tests, are usually done twice daily with a peak flow meter. again most asthmatics wouldn't routinely do oxygen monitoring tests using a pulse oximeter, as unless they are in the middle of an exacerbation, their oxygen levels will be normal (and may be even in an exacerbation). for a child, the recommendation would be to seek medical help if symptomatic of severe attack anyway, not make non medical decisions based on home oxygen monitoring with a pulse oximeter. cheap home pulse oximieters are inaccurate and can be affected by lots of variables

Would (could) she use any of these things and if so when / how -- Pulse Oximeter, Nebulizer, ET tube

see above. not convinced an ET tube would be used at home for asthma!?

Could she have any pets or would they stimulate an attack. If so, what could she keep as a pet?

depends entirely on the person and their allergies. I have four cats and a dog, as Im not allergic to either!

Is there a monitor that she could be hooked up to that lets off an alarm if she stops breathing at night? If so, how would this work?

I think you are getting asthma mixed up with other things. Asthma is totally different to obstructive or restrictive sleep apnoea. You don't just stop breathing when you have asthma. And if she had OSA diagnosed, she would be treated with a NIV machine (non invasive ventilation). The primary cause of OSA is obesity.

If during a later scene she suffers a severe attack in her sleep, would / could she fall unconscious? Would / could she stop breathing? And what would the mother then need to do to save her life?

The human body is designed to wake up if a threat to breathing - and it does. I might sleep through if Im a bit wheezy and short of breath (with nightmares about not being able to breathe!) but if having a severe attack I will wake - the physical exertion of struggling to breathe wakes you. The mother would ring 999, as a severe attack requires hospital treatment. If she had a home nebuliser (less likely in a child) she could administer this

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1) The kind of invalid you are imagining for your script would be unlikely to have only asthma. Asthma by definition involves ***variable*** obstruction of breathing. If this little girl had asthma as her only problem, she would sometimes breathe fairly well and sometimes breathe quite poorly. What makes severe asthma so difficult is that one never knows when one is going to be breathing well, when one is going to be breathing poorly, and when one is poorly for how long. That's why Soph says that there might be nebulizers around the house: that way if she started having a problem then she'd have something to help her in every room.

If you want a character whose breathing is a problem ****all*** of the time, you'd be better off having your character have something like cycstic fibrosis or some other lung disorder.

2) I'm not sure they even use O2 tents anymore except perhaps for children under three (wwwappskc.lonestar.edu/prog... and even for infants there are now nasal canulas.

3) Severe attack at night: for many people breathing is a problem particularly in the early hours of the morning. If you need a warning system, I suppose at night you could put a pulse-oximeter monitor on her finger. If you used one like they use in hospital (which is hooked up to a small monitor on a stand) then the parent could set an alarm that would go off if her O2 sats dropped below a certain level. But I think it would be unusual for a child to be at home if they were ill enough to be hooked up to a monitor like that at night as a regular thing. Most parents would bring their child to the hospital if they were that ill because the child would likely need treatment that can't be given at home. A more likely scenario would be that the parents had an arrangement with the hospital where the child was immediately admitted without having to go through A&E.

4) I think if you look in the parents and carers section of the forum you'll find that one big challenge for parents is figuring out whether or not their child is having trouble. It would be loevely if your film took that into account rather than simply portray the stereotype of an ""help I can't breathe! "" asthma attack. *some* asthma attacks look that way, but very many do not. The child just gets a little slower or quieter. They may cough instead of wheeze. They may complain of a tummy ache (comes from using accessory muscles to breathe). There are very many variations.

5) I would really recommend that you find a contact such as a pediatric pulmonologist or respiratory nurse and ask them. People watch movies nd form their ideas of what to do in emergencies from them. You can't avoid either informing or misinforming, depending on how you decide to write the scene. Personally, I'm uncomfortable with someone portraying something other than ""best practice"" at home, unless the failure to use best practice and the results from that are part of the plot line. And to get best practice, you need to talk to professionals.

I think asthmatics and parents of asthmatics aren't really qualified to discuss ""best practice"" because we know what we've been told for our particular situation. We don't know all of the different variations and if you take a little here and a little there from different asthmatics you are liable to get a meaningless combination that is one part camel and one part fish. Asthmatics and parents of asthmatics are better suited to talk about what it *feels* like to be asthmatic or how we cope with particular treatments or the challenge of ""now I/my daughter can breathe - whoops now we can't).

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5) I would really recommend that you find a contact such as a pediatric pulmonologist or respiratory nurse and ask them. People watch movies nd form their ideas of what to do in emergencies from them. You can't avoid either informing or misinforming, depending on how you decide to write the scene. Personally, I'm uncomfortable with someone portraying something other than ""best practice"" at home, unless the failure to use best practice and the results from that are part of the plot line. And to get best practice, you need to talk to professionals.

Absolutely.