Top Lung Health

Reacting to a comment about never using antibiotics. You can watch the video on my YouTube channel, here: https://youtu.be/LyCejRAxA3w

Familial pulmonary fibrosis means that there are several cases of pulmonary fibrosis in the same family (among blood relatives).

What are some common causes for breathlessness? Why do you get short of breath on exertion?

What is pulmonary fibrosis (scarring of the lungs)? In this episode I provide a thorough overview and highlight the difference between progressive and non-progressive lung fibrosis, causes, getting a clear diagnosis, follow-up over time and treatment. 

Causes of pulmonary fibrosis may include: severe lung infections, such as tuberculosis (TB); systemic/autoimmune diseases; environmental factors, such as dusts, hypersensitivity to various things - bird proteins, mold, humidifiers, farm workers, compost, saw dust - literally anything; undetermined causes (idiopathic pulmonary fibrosis - IPF).

The diagnosis is usually made using a combination of tests, which may include: imaging - HRCT, respiratory tests (lung function tests), blood tests, bronchoscopy, lung biopsy. The results are then typically brought to a multidisciplinary discussion (MDT) where several specialists make the final diagnosis. 

Treatment involves many components - it is not just medication. If the fibrosis is extensive or there is a risk of progression, it is extremely important to have regular check-ups with a doctor in order to carefully observe the fibrosis over time. This is usually done by repeating lung function and imaging over time, as well as monitoring symptoms. 

Sometimes no treatment for fibrosis may be recommended or there may not be effective therapy available, and in such cases symptomatic treatment may sometimes be given. 

Eliminating the cause is extremely important. Stopping smoking usually helps, as well as paying attention to causes from the environment, in case there is a component of hypersensitivity (birds, moldy hay, animals, agriculture etc.). 

Medication usually involves anti-inflammatory or antifibrotic treatment, which is chosen depending on the cause of the lung fibrosis. Anti-inflammatory agents may include corticosteroids (e.g. prednisone) or immunosuppressants (methotrexate, mycophenolate). Antifibrotic drugs which are currently approved include nintedanib (Ofev) and pirfenidone (Esbriet). These are both indicated for idiopathic pulmonary fibrosis (IPF), while nintedanib (Ofev) can sometimes be used in other forms of progressive fibrosis (which meet certain criteria). 

Oxygen therapy is also very important as a form of treatment, to correct low levels in the blood and ensure that other organs such as the heart are operating efficiently. 

Pulmonary rehabilitation by maintaining physical exercise is extremely important. Keeping fit to the extent possible will ensure that the body will cope with the reduction in lung function better. 

Treatment of symptoms may involved having medication for chronic dry cough or shortness of breath. Treatment of associated diseases which may contribute to these symptoms is also essential (i.e. it is not always only the fibrosis causing the symptoms). Psychological counseling and cognitive-behavioral therapy can help with anxiety and panic attacks which may occur due to sudden episodes of breathlessness and changes in lifestyle. 

Participation in clinical trials helps drive the science of pulmonary fibrosis forward and may offer early access to innovative therapies. Taking part in research also means that the condition is observed more carefully, with regular lung function and consultations. 

I do encourage patients to join local support groups and patient associations in order to meet others coping with pulmonary fibrosis and get updates from a patient perspective. Some of these groups can be found by asking at the local hospital or on social media (i.e Facebook).

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How to improve cough at home after a cold or a chest infection. Get rid of your cough faster by allowing your airways to recover faster: 

1) use soothing lozenges, honey or tea 

2) keep well hydrated 

3) avoid very dry air in your home 

4) get rid of excessive nasal secretions (ex. saline nasal wash) 

5) control acid reflux by being careful with your diet 

6) stop smoking if you are a smoker 

7) keep your room well ventilated to breathe clean air

Once you feel better, try to go outside for fresh air as much as possible.

Remember you can watch most episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Find more information on the website: https://www.toplunghealth.com/

Twitter: Stefan Cristian Stanel (@scstanel) / Twitter

Asthma Q&A session about some of the questions I received on my YouTube channel.

Remember you can watch most episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Find more information on the website: https://www.toplunghealth.com/

Twitter: Stefan Cristian Stanel (@scstanel) / Twitter

Inhalers cause weight gain? It is a common question and search topic online. Many inhalers do contain a low dose of corticosteroids, however this dose is usually too low to cause any significant side effects throughout the body. Inhalers allow the medication to be delivered directly to the airways, where it acts directly. Most inhaled medication is not absorbed at a significant level in the rest of the body. This is unlike tablets, which need to dissolve in the body's fluids at a sufficient concentration to cause an effect in distant organs. Weight gain directly linked to inhalers would be extremely unlikely.

Most often there are other issues at play, such as deconditioning. People with chronic respiratory disease often end up being less and less active due to their symptoms. This in turn leads to muscle wasting and worse capacity to exercise. It is a vicious circle that can be hard to break. Similarly, other concurrent medical problems may contribute to weight gain.

Remember you can watch most episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Find more information on the website: https://www.toplunghealth.com/

Twitter: Stefan Cristian Stanel (@scstanel) / Twitter

A live explanation about familial pulmonary fibrosis (FPF) or familial interstitial pneumonia (FIP). Familial cases can be caused by variants in something called telomere-related genes. Telomeres are repetitive sequences of DNA at the end of chromosomes which protect the DNA during cell division. Chromosomes are structures in the nuclei of cells which contain the DNA in a tightly packed form.  Familial pulmonary fibrosis can appear at the same time as other conditions (not related to the lungs) which also share a telomere-related issue. 

See the video in higher resolution directly on YouTube: https://youtu.be/qbiiKctxpU8

Remember you can watch most episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Find more information on the website: https://www.toplunghealth.com/

Twitter: Stefan Cristian Stanel (@scstanel) / Twitter

In this episode, I discuss some commonly asked questions about pneumonia treatment. Simple episodes of pneumonia normally do not require a lot of treatment and can be safely managed at home. Typically, an antibiotic is prescribed, with or without some other treatments to help manage symptoms.   

The antibiotic is the main treatment for the bacterial pneumonia and should be taken as prescribed. Some antibiotics are only taken once daily, while others can be given twice or three times daily. Taking your antibiotic more or less often than prescribed is usually not a good idea. The timing of the antibiotic depends on its pharmacological properties (how long it takes to clear it from your body). Your doctor will generally give you a prescription for the right amount of antibiotic at the right time and only adjust this if you are not really feeling better.   

Probiotics (medications to protect your gut flora) are sometimes also given with the antibiotic or recommended by your pharmacist. These are not often required as they are not a guarantee that you will not get digestive side effects from the antibiotic. Some antibiotics are more likely to affect the gut flora than others. I would recommend you talk to your doctor to see if a probiotic would be indicated in your case.   

Vitamin supplements are also not necessary for most people who get pneumonia, as long as they have a healthy diet and lifestyle. There is a lot of marketing around supplements, but most people don't actually need them.   

Finally, a chest X-ray is not generally required to check if the pneumonia is gone. If a chest X-ray film is done too early after pneumonia, it will still likely show abnormalities, as it usually takes up to 6 weeks for the images to return to normal. Therefore, in most cases of pneumonia, a follow-up chest x-ray is not immediately requested. Your doctor may however ask you to repeat the X-ray a few months after in case they have any specific concerns.

Remember you can watch many of these episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Find more information on the website: https://www.toplunghealth.com/

Twitter: Stefan Cristian Stanel (@scstanel) / Twitter

A comment about persistent cough and taste abnormalities after COVID. How long to wait until seeing a doctor about the cough? 

A residual cough is very common after chest infections including COVID. Normally if the cough lasts for more than 6-8 weeks with no sign of improvement it may be a good idea to ask for a medical opinion in your case. Most often there may be some ongoing inflammation that may improve with time or it could be sustained by other issues you may be having (such as acid reflux, post-nasal drip from chronic rhinitis etc.). Sometimes the cough may be the sign of a complication from the chest infection or something more serious. Knowing the cause of the cough is the most important thing (if it is not going away on its own). 

You should always see your doctor if you are worried about your health!

Remember you can watch many of these episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Find more information on the website: https://www.toplunghealth.com/

Twitter: Stefan Cristian Stanel (@scstanel) / Twitter